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Bulletin 

OF THE 

SCHOOL OF MEDICINE 



UNIVERSITY OF MARYLAND 



Vol. 42 
1957 



UNRTRSITY OF MARYLAND 
SCHOOL OF MEDICINE 

ADMINISTR.ATI\T OFHCERS 

Wilson H. Elkins. B.A.. M.A.. Litt.B.. Ph.D President 

William S. Stone, M.S.. M.D., D.Sc Director, Medical Education and Research, and Dean 

Dietrich C. Smith. B.A.. M.A.. Ph.D Associate Dean, Admissions and Student Affairs 

Robert T. Parker. A.B.. M.D Associate Dean, Curriculum 

Norma J. .Azlein. A.B Associate Registrar 

G. Watson Algire. M.S Director of Admissions and Registrations 



V 



HEALTH SCIENCES LIBRARY 

UNIVERSITY OF MARYU\ND 

BALTIMORE 




A(^3-35''?7 



INDEX 



Abbott, Alexander C, 89 

abortions, therapeutic, 48 

acid secretion in contact with antrum, 18 

acids, formation and excretion of, 6 

acute cerebrovascular disorders, serum and 

cerebrovascular disorders in, 20 
Albanese, Irby-Pope, Stevens copper method 

modified, 6 
aluminum chlorhydroxidc complex, 73, 74 
American Medical Association, ?>?> 
ammonia-free urines by aeration, 10 
Amodioquin (Camoquin) in treatment of 

discoid lupus erythematosus, 14 
Anatomical Hall. 30 
Anatomy, Clinical, 10 

Department of, 9 

Law, 33 
Anesthesiology, Department of, 39 
angina pectoris, 70 
antibacterial agents, 6 
antibiotics, 55 

anticonvulsant meprobamate, 2 
anticonvulsants, other, 4 
antiepileptic compound, 2 
anti-malarial drugs, action of, 14 
antiperspirant, antibacterial Deocin, 72 
Arthritis, Division of, 53 
aplastic anemia, fatal following use of 

mepacrine, 14 
Appellate Court, 57 
aromatic acid fraction, 10 

hydroxy acids, 7 
aspirin, related hydroxyaromatic acids, 12 
Association of American Medical Colleges, 1 
Atabrine, use of (mepacrine), 14 
Atlas of Anatomy by Grant, 67 
Ayd, Dr. Frank j., jr.. 2 

bacterial flora reduced by neomycin, 72 
Baker analyzed reagent, 8 
Baltimore, fire, 1904, 34 

General Dispensary, 1801, 27 

geographic center of the Republic. 27 

Infirmary, 1823, 31 

schools: University of Maryland. 36 

shipbuilding and trade, 27 
Base Hospital of University of Maryland, 35 
Basic Science Departments, 9 



Beck 1 operation, 71 

Bell, John, 63 

Bicentennial of School of Medicine, 69 

iiilateral frontal burr holes, 76 

Billroth, 18, 19 

gastric resection, 1881, 17 
Biochemistry, Department of, 21 
black smallpox, 59 
Blalock, Dr. Alfred, 70 
blood-brain barrier, 25 
bloody spinal fluid, 61 
Board of Examiners, Medical and Chirurgical 

Faculty, 28 
Board of Regents, 35 

Board of Trustees, Uni\'ersity of Maryland, 31 
book review, 67 
brain tumor patients, 24 
Bressler, Dr. Frank C, 35 
Bressler Research Laboratory, 35, 39 
Brown, Dr. James, 90 

Camoquin, 14 
Cardiology, Division of, 54 
catatonic cases, report of, 78 

patients treated with intraventricular 
cholinesterase, 75 

stupor, 75 
Centennial Celebration, 35 
Cesarean sections, 48 

forceps, 42 

previous, 43 
cerebral ventricles, 75 
cerebrospinal fluid, determination ot transami 

nase acti\'ity in blood, 61 

GOT levels among miscellaneous types ol 
neurologic diseases, 25 
cerebrovascular lesions, 20 
cervico-thoracic sympathectomy. 7 1 
Chemical Hall, 30 
chemotherapeutic agents, on nitrogenous, 

phenolic constituents of rat urine, 6 
Chesney, Dr. Alan M., 54, 86 
C'hloroquine, \'alue of, 14 
cholinesterase, intra\'entricular, 75 
C'linical, Departments, 39 

Pathology, Division of, 57 
Civil WarV32 
College of Medicine of Maryland. 1807, 28 



3^ 



224 



UNIVERSITY HOSPITAL 



College of Ph\sicians and Surgeons, School of 
Medicine, University of Maryland, 27 

complications of delivery, 45 

congenital hvdrocephalus, 25 

Cordell, Dr. Eugene F., 34 

coronarv, arterial insufficiency, 70 
atherosclerosis, 70 

Councilman, Dr. William T., 88 

Crawford, Dr. John— vaccination 
introduced, 27, 29 

Danville, Kentucky Ephriam McDowell, 63 

Darwin, Charles, 62 

Davidge Hall, 1905, 29, 30, 39 

Davidge, Dr. John, iirst Dean, 1, 27, 28, 64 

Dean's Report, 1 

Dean William S. Stone, 39 

deliveries, bv presentation, 42 

prenatal examinations, 41 
Dental Surgery, Baltimore College of, 31 
Deocin, effects of repeated application of, 73 

new antibacterial antiperspirant, 72 
deodorants, 72 

Dermatology, Division of, 63 
determination, of transaminase activity in bloody 

cerebrospinal fluid, 61 

of various urinary nitrogenous 
constituents, 6 
diazotized pnitroaniline procedure, 10 
discoid lupus erythematosus treated with 

Camoquin, 14-16 
dissection made compulsory, 32 
Dragstedt of Chicago, 1942, vagotomy, 17 
duodenal ulcer, 1 7 

editorial, 53-69 

Sesquicentennial, 1 
Edkins' observations on antral secretory 

hormone, 1906, 19 
effect of ether extracts oi hydrolyzed human 

urine on rats, 12 
electroencephalographic studies, 76 
antibiotics and rat urine by Schmidt, 1 1 
epidemics, early, 27 
cpisiotomy, 43 

ether extracts of hydrolyzed human urine, 12 
excretory level, change in, 1 1 
Faculty of Physic, College of Medicine, 29 
feeding, bacitracin on nitrogenous, phenolic 

constituents of rat urine, 9 

chlortetracycline hydrochloride on nitrogen- 
ous, phenolic constituents of rat urine, 9 

ether extracts of hydrolyzed human urine on 



growing rats, effects of, 12 
firsts in American medicine, 1 
Fisher, Russell S., M.D., 55 
Flaxedil and Procaine, 75 
Folin-Ciocalteau reagent, 7, 8 
Fonerden, Dr. John, 86 
Founding of University of Maryland, 1 
future plans, 38 
Gardenier, Jean, B.S., 6 
gastric resection, Billroth, 1881, 17 
gastrin, antral secretory hormone, 19 
gastroduodenal anastomosis, 1885, Billroth, 17 
Gastroenterology, Division of, 69 
gastrojejunostomy, 1 7 
General Surgery, 165 

glutamic o.xalacetic transaminase (GOT), 20, 61 
GOT activity in acute cerebrovascular 

accident, 21-23 
growth stimulation in rats by antibiotics, 10 
Gynecology and Obstetrics, Department of, 93 

Halsted, Dr., 88 

Harkins, Henry N., M.D., Ph.D., 17 

hemorrhage, deliveries with, 47 

Hopkins, Johns, 86 

human dissection, early prejudice against, 28 

Humphreys, Dr. Alexander, 63 

hydrolyzed, human urine, 12 

urine, extraction of, 7 
Hypertension, Division of, 70 

Industrial Accident Commission, 55 
Infection, medicolegal aspects of, 55 

unsterile instruments, 58 
Infectious Diseases, Section of, 72 
insulin, 75 

resistance, 76 

tolerance curves, 77 
inter-coronary collateral vessels, 70 
intestinal flora, antibiotic effect on, 12 
intramuscular bismuth subsalicylate, 14 
intraventricular cholinesterase, 75 

Jenner, Edward, 27 

Johns Hopkins Flospital, 87 

Nurses' Training School, 33 

University School of Medicine, 32, 54, 86 
J(mnesco of Bucharest, 1916, 71 

Karmen, 61 

spectrophotomctric method, 20 
Keetley, 1902, primary gastric resection, 18 
Kelly, Dr. Howard A., 88 



INDEX 



^25 



Kessler, Gerald, Ph.D., 6, 12 
Klett-Summerson photometer, 8 
Krantz, John C, Jr., Ph.D., 62 

L.E. cell phenomenon, 14 

lichenoid eruption, 14 

lichen planus, 14 

Lincoln, Abraham, 62 

Lister, 1867, 17 

live births according to weight, 44 

Longfellow, Llenry V\'adsworth, 62 

longitudinal tubular resection witli transverse 

gastroplasty, 18 
lotteries for raising monev for building, 27 

Manteno State Hospital, 75 

Martin, Professor H. Newell. 88 

maternal deaths, 49 

McDowell, Ephriam, 62 

Medical, Chirurgical Faculty, 1, 27, 86 

college created, 69 

Library, of Dr. John Crawford, 29 

license laws, 28 

school curriculum, 32 
Medicine, Department of, 43 

Out-Pa tient Department, 83 
medicolegal aspects of infection, 55 
meprobamate (Miltown), 2 

dosage and treatment with, 2 

in epileptic children, 4 

side reactions of, 4 

therapy, 2 

used as an anticonvulsant, 3 
Micro- Anatomy, 10 
Microbiology, Department of, 25 
Miyazaki, Motoji, M.D., 20, 61 
Morison, Dr. Robert B., 90 
Mosberg, William H., Jr., 75 
"museum" of earlv University of Md., 31 
myocardial infarction, 70 
myocardium, 71 

neomycin, lessens bacterial Hora, 72 
Neuro-Anatomy, 10 
neurologic, diseases, 20 

Surgery, 196 
Neurology, Division of, 77 
Neurosurgery, Division of, 200 

obstetric case report, 5L 65, 92 
Obstetrics and Gynecology, Department of, 93 
summary of admissions and prenatal 
mortality, 41 
officer personnel of 42nd and 142nd general 



hospitals, 37 
operations for delivery, 42 
Ophthalmology, Department of, 103 
Orthopedic Surgery, 186 
Osier, Dr. Willkm', 88 
osteomyelitis of the mandible, 57 
Otolaryngology, Division of, 21 1 
Out Patient Department, Johns Hopkins, 89 

Medical, 83 
(warian cyst, 62 

twisted, 93 
()\'ariotomy. Dr. Ephriam McDowell, 30 

Page, use of mepacrine (Atabrine), 14 
Pathology, Department of, 105 

Division of Clinical, 57 
Pediatrics, Department of , 109 
Perinatal mortality, 40 

etiology of, 45 
pelvis, deliveries by, 47 
peptic ulcer, 17 
perforated duodenal ulcer, 1 8 
Pharmacy, School of, 3 1 
Pharmacology, Department of, 33 
phenol, concentrated, 71 

p-cresol fraction, 10 
phenolic compounds, 8 
Physiology, Department of, 35 
Pincoffs, Maurice C, M.D., 53 
pituitary-adrenal system, antibiotic effect on, 12 
Plaquenil, value of, 14 
Pope and Stevens, copper method modified by 

Albanese and Irby, 6 
Postgraduate Committee, 123 
Potter, Dr. Nathaniel, 1797, 27 
Practice Hall, 1821, 31 
prematurity, immaturity, 45 
prenatal examinations, deli\'eries, 41 
Preventive Medicine, 53 

and Rehabilitation, Department of, 129 
Primary gastric resection, Keetley, 1902, 18 
prolonged labor, 46 
prophylactic treatment, 58 
Psychiatric Institute, 39 
Psychiatry, Department of, 1 3 1 
Psychology, Department of, 1 42 
Public Hospital erection, 1798, 27 
puerperal morbidity, deliveries according to, 47 
Puget, Stephen: views on cardiac surgery, 

1896, 19 

quinacrine, value of, 14 



226 



UNIVERSITY HOSPITAL 



Radioactive Isotopes, Division of, 85 
Radiologv, Department of, 51, 161 
Randolph. Dr. Robert L., 90 
recoverv of phenols and aromatic hydro.xy acids 

extracted at various pH, 8 
re dedication. 64 
Rehabilitation and Prc\enti\e Medicine, 

Department of, 1 29 
Report of the Dean, 1 
Rh negative deliveries, 46 
Robinson, Harry M., Jr., M.D., 14, 72 
Robinson, Raymond C. V., M.D., 14, 72 
roentgen peKimetry, 52 
role of surgerv in management of cort)nary 

arterial insufficiency, 70 

Sabiston, Dr. David C, Jr., 70 

Sahyun and Russell methods on urines, 10 

Savage, lohn E., M.D., 27 

Schmidt', E. G., Ph.D., 6 

Section of Infectious Diseases, 72 

serum, and cerebrospinal fluid levels, 20 

hepatitis by transfusion, 58 

reaction, 57 
Sesquicentennial, Convocation, 86 

Editorial, I 
Shelley and Cahn, 1955, neomycin, 72 
Sherwood, Dr. Stephen L., 75 
silver nitrate, 58 
skin, yellow piginent in, 14 
Smith, Dr. Alan Penniman, 86 
Southern Homeopathic Medical College, 32 
spectrophotometric method, Karmen, 20 
spinal anesthesia, 24 
Sprague-Dawley female rats, 12 
sterilizations, 49 
steroid therapy, local, 73 
stillbirths, according to weight, 44 

neonatal deaths according to weight, 44 
stomal ulcer, 18 

Stone, Dr. William S., Dean, 39 
Strahan, John F., M.D., 14 
strepticoccal septicemia, 59 
Surgery, Department of, 165 

of duodenal ulcer, 17 

General, 165 

Neurologic, 196 

Orthopedic, 186 

Thoracic, 205 
synaptic depressant drugs, 75 



systemic lupus cr\'thcmatosus, 14 

"t test", 13 

Testimonial Dinner for Dr. Pincofts, 54 

tetanus antito.xin, 56 

Theobald, Dr. Samuel, 89, 90 

therapeutic results of meprobamate as 

anticonvulsant, 3 
Thomas, Dr. James Carey, 87 
Thoracic Surgery, 205 
toward the third century, 69 
toxemia, deli\eries with, 45 
transaminase actix'itv, 61 

University Hospital, 33, 216 

University of Maryland, School of Medicine, 

College of Physicians and Surgeons, 27, 32 

contributes to Johns Hopkins School of 
Medicine, 86 

School of Medicine, early development of, 33 
urinary, amino acid nitrogen, 6 

phenols in rats, 6 
urine collection from female rats, 6 
Urology, Division of, 189 

vaccination tor smallpox, Jenner, Crawford, 27 
vagotomy, 1942, Dragstedt of Chicago, 17 
Van Buskirk, Charles, M.D., 25 
Vanderlinde, R. E., Ph.D., 12 
volatile amines from alkalinized urine by 

aeration, 6 

phenols, aromatic hydroxy acids, 
determination of, 7 
\'on Haberer, 1919, primary resection, 18 

Wakim and Fleisher, increase of cerebrospinal 

fluid transaminase, 20 
Wangensteen of Minneapolis, wedge resection 

of corpus leaving antrum intact, 18 
Washington, George, 27 
wedge resection of corpus leaving antrum intact, 

Wangensteen of Minneapolis, 18 
Weinberg of Long Beach, \'agotom\' combined 

with gastrojejunostomy, pyloplasty, 17 
Welch, Dr. William H., '88' 
Williams, Dr. John Whitridge, 90 
Wolfler, 1881, gastrojejunostomy, 17 
Woman's Medical College of Baltimore, 32 
\\'orld War II, 39 



SESQUICENTENNIAL YEAR 

1807-1957 




OF 

THE SCHOOL OF MEDICINE 

UNIVERSITY OF MARYLAND 

VOLUME 42 January J 1957 number i 

EDITORIAL 

SESQUICENTENNIAL 

It is \957 and the 15()th year of the University of ^Maryland School of Medicine. 
This, the tifth oldest medical college in North America, has enjoyed a continued 
existence which augurs well for the quality of the men who founded the school and 
the philosophy upon which their successors have so effectively continued. 

In the past century and a half medical education and medicine itself have changed 
greatly from the simple didactic and empiric principles known to John Davidge and 
his associates who, in 1807, in cooperation with the Medical and Chirurgical Faculty 
founded Maryland's first medical school. 

In its past the School of Medicine claimed a number of important firsts in American 
medicine. It was here that for the first time compulsory human dissection was begun. 
Here, bedside teaching in medicine was first conceived. The University also was a 
leader in the development of teaching in the specialties. It was at the University of 
Maryland in 1853 that the microscope was first used in America for the diagnosis of can- 
cer. Many of her brilliant alumni have been honored for the discovery of new diseases 
and in the development of therapy. The University was one of the leaders in the founda- 
tion of the Association of American Medical Colleges. It figured prominently in two 
World Wars and the American Civil War. The rich history of tradition, the con- 
tinuing medical research and educational activity, in the oldest building in America 
still devoted to medical education, signals the beginning of a new era. 

The School of Medicine of the University of Maryland, now a part of the Univer- 
sity of Maryland, rests not upon the laurels of its interesting and illustrious past. 
New revisions in facult}-, policy, staffing, curriculum and a sturdy progressive build- 
ing program give i)romise of continuing develoj)ment in the centuries which lie ahead. 

With a rich heritage from the i)ast. Alumni and faculty accept the challenge of a 
future which certainly has a </ood beginning on a fertile background. 



MKI'KOHAMATETllKRAI'N' lOR TOWl LSI\ K DISORDERS 
OF CHILDREN* 

FRANK J. AVI), JR.. M.I). 

BALTIMORE, MARYLAND 

Although the drug management of convulsive disorders has improved considerably 
in recent years, epileptologists are always interested in new anticonvulsants. Conse- 
([uently, when the pharmacologic studies of meprobamate (Miltown)* revealed it to 
be a potent anticonvulsant in animals, a clinical trial of thisdrugfor the management 
of convulsive disorders of children was undertaken. The results of this investigation, 
which was conducted for one year, are disclosed in this report. 

CLINICAL MATERIAL 

Twenty-hve children between the ages of 6 and 15 were selected f(jr this j)r()iect. 
These patients were known epileptics whose seizures had been refractory to pro- 
longed treatment with other antiepileptic compounds. The frequency of their sei- 
zures had been recorded from a minimum of six months to a maximum of three 
years prior to this investigation. A similar record was kej)t during the time of 
meprobamate therapy. 

This group was composed of ten children with organic brain disease subject to 
grand mal seizures, ten children with petit mal epilepsy and five children with 
myoclonic seizures. All of these children were treated on an ambulatory basis and, 
with the exception of two, all were attending school. Thus, in addition to the sur- 
veillance of the research team, these children were observed by their parents, 
teachers, school nurses and family physicians. From these sources, information was 
gathered regarding the frequency of the seizures and any undesirable effects of the 
test medication. 

DOSAGE AND TREATMENT 

Initially, mei)robamate was prescribed in combination with whatever other anti- 
convulsant medication the patient was receiving. The younger and physically smaller 
children were begun on 200 mgm. three times a day or four times a day. The starling 
dose for the larger adolescents was 400 mgm. three times a day or four times a day. 
Within the next month all other medication was withdrawn gradually as the dosage of 
meprobamate was increased. In those patients with grand mal epilepsy, however, this 
technique of therapy resulted in an exacerbation of seizures. C\)nsequently for these 
patients it was necessary to continue their antiepileptic drugs along with meproba- 
mate. The patients with petit mal epilepsy and myoclonic seizures were treated with 
meprobamate alone. In either case the dose of meprobamate was increased until 
clinical benefit was achieved or toxic symptoms intervened. The maximum dose 
administered was 5600 mgm. daily. The average therapeutic dose was found to be 
1600 to 4000 mgm. daily. There was no correlation between the o|)limal dose and the 

Received for publication October 8, 1956. 

* Meprol)amale (Miltown) supplied by Wallace Laboratories, New Brunswick, New Jersey. 

2 



FRANK J. AYD, JR.— THERAPY FOR CONVULSIVE DISORDERS 3 

weight of the child. Likewise, these children tolerated even the large doses of meproba- 
mate as well as, if not better than, adult patients in another clinical trial of this drug. 

THERAPEUTIC RESULTS 

At the end of one year the degree of seizure control obtained with meprobamate was 
determined by comparing the incidence of seizures during the last month of therapy 
with the average monthly frequency of seizures for the six months prior to this investi- 
gation. By this method it was possible to employ the following criteria to define the 
anticonvulsant activity of meprobamate: 

A. Marked improvement indicates more than a 75 per cent reduction in the 
frequency of the seizures. 

B. Moderate improvement means over a 50 per cent reduction in the frequency of 
the seizures. 

C. No improvement signifies no essential change in the patient's clinical condition. 

D. Worse indicates an increase in the frequency of the seizures. 

The findings in this study are summarized in Table 1. This reveals that meproba- 
mate is not an effective anticonvulsant for grand mal epilepsy. Only one of the ten 
patients with grand mal seizures obtained moderate benefit when meprobamate was 
combined with this patient's other antiepileptic medication. The remaining patients 
with grand mal seizures experienced an increase in the frequency of seizures when an 
attempt was made to withdraw their previous anticonvulsants and substitute mepro- 
bamate. In fact, six of these patients were made worse even when the only change in 
their treatment consisted in the addition of meprobamate to their medication sched- 
ule. It may be concluded, therefore, that meprobamate is contraindicated in patients 
with grand mal seizures resulting from organic brain disease. 

In contrast to the ineffectiveness of meprobamate in grand mal epilepsy and its 
propensity to precipitate grand mal seizures this drug proved to be quite beneficial 
in controlling petit mal seizures and myoclonic seizures. Of the ten patients with 
petit mal epilepsy, meprobamate alone produced marked improvement in four 
patients and moderate improvement in three patients while two patients were un- 
improved and one was worse. Equally impressive was the reduction of myoclonic sei- 
zures by meprobamate. The drug caused a marked improvement in one patient and 
moderate improvement in three patients. Only one patient with myoclonic seizures 



TABLE 1 

A nticonvulsant A clivity of Meprobamate 



Seizure Control 


Grand Mal 


Petit Mal 


Myoclonic 




No. 


% 


Xo. 


% 


No. 


% 


75-100% Reduction 
50-75% Reduction 
50%, Or no reduction 
Increased seizures 




1 

3 
6 



10 
30 
60 


4 
3 
2 

1 


40 
30 
20 
10 


1 

3 
1 



20 

60 

20 




Total no 


of patients 


10 




10 




5 





4 BULLRTIX OF THE SCHOOL OF MEDICINE, U. OF MD. 

was unimproved during ihis (.linical trial. Tluis il is apparent that meprobamate 
possesses anti-convulsant proj)erlies wtiich make it an effective drug for petit mal 
seizures and myoclonic seizures. 

sidl: rk.\ctio.\s 

Meprobamate is not an innocuous compound. It may cause side effects, some of 
which may be (|uile troublesome and potentially serious, and necessitate discontinu- 
ation of the drug. The side reactions encountered in this investigation involved 
chietlv the central nervous system and the gastrointestinal system. Drowsiness v/as 
the most common side effect. It occurred in eight patients. Two children on large 
doses became ataxic. Tremor was observed in one patient and incoordination in three 
patients. One patient complained of abdominal discomfort, while another had anor- 
exia. Nausea without vomiting was mentioned by three children. The most serious 
reaction to meprobamate was a generalized allergic dermatitis of sufficient severity 
to warrant immediate termination of treatment. A positive patch test confirmed 
this patient's sensitivity to meprobamate. 

There was no direct relationship between the occurrence of these side reactions and 
the dosage of meprobamate with the exception that the central nervous system reac- 
tions were more Ukely to occur with doses in excess of 2400 mgm. daily. These neuro- 
logic and gastro-intestinal responses to meprobamate disappeared with a reduction 
of the dosage. They recurred when a subsecjuent increase of the dosage of mepro- 
bamate was tried. 

Routine blood studies and urinalysis did not disclose any abnormality during the 
course of treatment. However, these negative findings in such a small number of 
patients do not permit the assumption that meprobamate has no deleterious effects 
on the blood forming elements. For this reason repeated blood examinations should 
be done in all patients receiving this drug until its safety has been established posi- 
tively. 

COMMENT 

In addition to its anticonvulsant activity meprobamate also seems to allay anxiety 
in epileptic children. This was apparent even in those children who were unimproved 
and to some extent in the children whose epilepsy was aggravated. This mitigation 
of tension and anxiety undoubtedly helped to further reduce the frecjuency of seizures 
in those children in whom emotional stress triggered seizures. 

No difficulty was encountered in administering meprobamate to these children. 
They did not object vociferously even when side reactions occurred, probably be- 
cause immediate relief followed reduction of the dose. The absence of visual disturb- 
ances, which some of the children with petit mal seizures experienced with other 
anticonvulsants, pleased this group of patients. 

This preliminary clinical evaluation suggests that meprobamate has advantages 
over other anticonvulsant drugs for petit mal epilepsy and myoclonic seizures. How- 
ever, because of the relatively small number of patients in this study, a more com- 
prehensive clinical trial is needed to further validate these findings. 



FRANK J. AYD, JR— THERAPY FOR CONVULSIVE DISORDERS 5 

SUMMARY 

To evaluate the anticonvulsant effectiveness of meprobamate this drug was ad- 
ministered to twenty-five previously uncontrolled epileptic children. Ten of these 
children were subject to grand mal seizures; ten had petit mal seizures, and five had 
myoclonic seizures. After one year the degree of seizure control obtained with mepro- 
bamate was determined by comparing the incidence of seizures during the last month 
of therapy with the average monthly frequency of seizures for the six months prior 
to this investigation. 

Meprobamate is of little value for grand mal epilepsy since it made six of the ten 
children worse; had no effect on three and produced moderate relief in only one. By 
contrast, this drug is effective in reducing the frequency of petit mal seizures and 
myoclonic seizures. Seven of the ten children with petit mal seizures were benefited by 
this drug. Four of five children with myoclonic seizures were improved. The average 
therapeutic dose was found to be 1600 mgm. to 4000 mgm. daily. 

The side reactions which occurred involved chiefly the central nervous system and 
the gastro-intestinal system. These toxic reactions disappeared with a reduction of 
the dosage of meprobamate. One patient had a severe generalized dermatitis which 
required immediate termination of treatment. A patch test showed this patient to be 
sensitive to meprobamate. Otherwise, this drug was well tolerated and easily admin- 
istered to the children. 

Meprobamate has some advantages over other anticonvulsants for the minor con- 
vulsive disorders of children such as the allaying of anxiety, tension and the absence 
of visual disturbances. 

BIBLIOGRAPHY 

1. Berger, F. M.: The anticonvulsant activit}' of carbamate esters of certain 2,2-disubstituted- 

1 ,3-propanediols. Journ. Pharmacology and Experimental Therapeutics, 104(2), February, 
1952. 

2. Berger, F. M.: The pharmacological properties of 2-methyl-2-n-propyl-l,3-propanediol dicarba- 

mate (Miltown), a new interneuronal blocking agent. Journ. of Pharmacology and E.xperi- 
mental Therapeutics, 112(4), December, 1954. 
3 Hendley, CD., Lynes, T. E. and Berger, F. M. : Eflfect of 2-methyl-2-n-prop)'I-l , 3-propanediol 
dicarbamate (Miltown) on central nervous system. Proceedings of the Society for Experi- 
mental Biology and Medicine, 87: 608-610, 1954, 



EFFECT OF CHEMOIHERAPEUTIC AGENTS OX NITROGENOUS AND 
PHENOLIC CONSTITUENTS OF RAT URINE*tt 

E. G. SCHMIDT, Ph.D., JEAN GARDENIER, B. S., .\nd G. KESSLER, Ph.D. 

The manner in which chemolherapeutic compounds act as growth promotanls and 
as antibacterial agents remains largely a matter of conjecture (1). One theory suggests 
that the antibiotic suppresses organisms that cause "disease," usually in too mild a 
form to be recognized as such, and also organisms that normally destroy valuable 
nutrients or produce toxic putrefactive materials in the intestines. Observations on 
the effect of 3-nitro-4-hydroxphenylarsonic acid, chlortetracycline hydrochloride 
and bacitracin, when added to the diet of rats, on the formation and excretion of 
urinary phenols, aromatic hydroxy acids, amino acid nitrogen, ammonia, and total 
nitrogen are reported in this paper. 

MATERIALS AND METHODS 

Two female rats, each weighing about 200 gm., were housed in individual meta- 
bolism cages designed to permit collection of urine free from contamination by feces 
or feed. Each cage was placed in a large 9 inch glass funnel which contained a fine 
wire screen and 2 inverted watch glasses (2 and 4 inches in diameter). Feces were 
removed daily from the screen. The urine was collected under toluene. The pooled 
urine was transferred to the refrigerator twice daily and collected into consecutive 
48 hour specimens. The volume (60-130 ml.) varied with the diet and temperature. 
Watch glasses and funnels were washed down with small portions of water which 
were added to the urine. The samples were diluted to 100 ml., if necessary, and cen- 
trifuged. The animals were fed rapidly twice daily in separate boxes to avoid feed 
contamination. Drinking water was always available. Each chemotherapeutic com- 
pound was mixed with Hunt Club Lab Chow (Animal Foundation, Inc., of Sher- 
bourne, N. Y.) in amounts usually present in commercial supplemented feeds. 

DETERMINATION OF VARIOUS URINARY NITROGENOUS CONSTITUENTS 

While several methods are available for the determination of urinary amino acid 
nitrogen, each yields different values (2). In the present work, analyses were made by 
three procedures: (a) the copper method of Pope and Stevens as modified by Albanese 
and Irby (3) and (b) by two aeration-colorimetric procedures devised by us in which 
the ammonia and volatile amines are removed from alkalinized urine by aeration (4). 
Tube A contained 15 ml. of 20 per cent sulfuric acid, tube D 15 ml. of 10 per cent 
sodium hydroxide, and tube C 15 ml of N/lOO hydrochloric acid and two drops of 

Received for publication October 16, 1956. 

* From the Department of Biological Chemistr\-, School of Medicine, University of Marjland. 
Baltimore, Marj'land. 

t This investigation was sujijiorted in part by grants from the Division of Research Grants, 
National Institutes of Health, U. S. Public Health Service, and the Nutrition Foundation, Inc., 
N. Y. 

X The authors are indebted to Patricia Thorpe, Shirley Cox, Elizabeth Shaw, Flo Council!, and 
Arlie Parker for valuable assistance. 

6 



SCHMIDT ET A L.— ANTIBIOTICS AND RAT URINE 7 

methyl red. Three ml. or urine were diluted to 30 ml. and adjusted to pH 10.5 with N 
sodium hydroxide. Then 10 ml. were transferred to tube B. One ml. of antifoam mix- 
ture (1 volume of caprylic alcohol and 4 volumes of ethyl alcohol) was added to each 
tube and the apparatus aerated rapidly for two hours. When the ammonia was being 
determined, the contents of tube C was back-titrated with N/100 sodium hydroxide 
after aeration. 

Two 3 ml. alicjuots of the dilute aerated urine were just acidified to phenolphthalein 
with N/10 sulfuric acid and then made faintly alkaline. One ml. of sodium borate 
solution was added and the amino acid nitrogen analysis then completed according to 
the directions of Sahyun (5). Amino acid nitrogen was also determined by the Russell 
(6) modification of the Sahyun procedure. In the latter procedure 1 ml. of an acid 
formaldehyde solution replaces the usual acetic acid-acetate reagent and 0.05 M 
sodium thiosulfate, the 4 per cent solution. Prior to the addition of these solutions, 10 
ml. of water were added to each tube to prevent the development of turbidity. The 
contents were diluted to 25 ml. and read in the colorimeter against a similarly treated 
standard amino acid solution (6). 

For total nitrogen estimations, 5 ml. of urine were diluted to 100 ml. and 5 ml 
of the diluted urine then rediluted to 100 ml. Two 5 ml. aliquots were then di- 
gested, nesslerized, and read in the photometer against an ammonium sulfate 
standard. 

DETERMIN.\TION OF VOLATILE PHENOLS AND AROMATIC HYDROXY ACIDS 

Two fractions were obtained by ether extraction of hydrolyzed urine at pH 10 
(volatile phenols) and then at pH 1 (aromatic hydroxy acids). The extracts were 
analyzed by a diazotized p-nitroaniline procedure (7) and also by an adaptation of the 
blood phenol method (8) which utilized the Folin-Ciocalteau reagent (9). 

Four 5 ml. aliquots of urine were made up to approximately pH with 10 ml. of 
10 N sulfuric acid and 40 ml. of water and refiuxed gently for 1 hour. Each hydrolysate 
was adjusted to pH 10 at a volume of 200 ml., and a 40 ml. aliquot was transferred to 
a coaxial extraction tube (7). 

A glass bead and about 10 ml. of ether were added to each of four 25 ml. receiver 
flasks. Two of these flasks were attached to coaxial extraction tubes by standard 
taper joints and rapid extraction was instituted. The diazotized p-nitroaniline pro- 
cedure for the analysis of these extracts is described elsewhere (7). 

Our newer procedure utilizing the Folin-Ciocalteau reagent was carried out as 
follows. Five ml. of distilled water were added to each of the other two receiver flasks 
which were attached to the extraction tubes. The flasks were immersed in beakers of 
hot water on hot plates and rapid extraction was instituted for 23/2 hours. The flasks 
were then replaced by smaller flasks each containing a bead, 1 ml. of water and about 
3 ml. of ether. Extraction was then continued for an additional hour. Weakly acidic 
phenols and neutral substances were extracted at pH 10. The contents in the extrac- 
tion tubes were brought to pH 1 with 1 ml. of 10 N sulfuric acid. Extraction was 
resumed as described above. The more acidic materials were then extracted. 

The various receivers were immersed in hot water to evaporate the ether while the 
contents were continuously agitated. Twenty ml. of water were added to the large and 



BULLET I y OF TUE SCHOOL OF MEDICINE, U. OF MD. 



TAHI.I-. 1 
Recovery of Phenols and Aromatic Hydroxy Acids Extracted at \' or ions pH* 





pH of the Solutions and Per Cent Recovery 


Compound Kxtrailcd 


a 


b 


c 




pH8 


pH 1 


pH 9 


pH 1 


pH 10 


pH 1 


])-Cresol 


103 


— 


103 


_ 


101 


— 


Phenol 


98 


— 


98 


— 


96 


— 


Resorcinol 


90 


4 


80 


5 


70 


14 


Catechol 


15 


15 


12 


8 


10 


8 


p-Hj'droxybenzoic acid 


4 


99 


3 


101 


2 


103 


p-Hjdrox\phen\-lacetic acid 


1 


100 


1 


98 


1 


97 


p-Hj-droxyphenyllactic acid 


2 


94 


3 


93 


3 


95 


p-Hydroxycinnamic acid 


4 


103 


2 


105 


2 


105 


m-Hvdroxvbenzoic acid 


3 


103 


1 


103 


2 


105 


o-Hydroxybenzoic acid 


4 


96 


5 


98 


4 


98 



* 0.2 mg./40 ml. was extracted in each case except o-hydrox>'benzoic acid (2 mg.) where hydrogen 
bonding causes poor color formation. 

4 ml. to the small receiver flasks. Two 5 ml. aliquots of the former and the entire 
contents of the latter were transferred to test tubes. A blank was prepared by evap- 
orating 3 ml. of ether from 5 ml. of water. Then 0.5 ml. of the Folin-Ciocalteau re- 
agent and 1 ml. of 20 per cent sodium carbonate (prepared from anyydrous powder, 
'Baker Analyzed' Reagent, low in iron) were added. All tubes were immersed in boil- 
ing water for exactly one minute and then immediately in cold water. The readings 
were made in a Klett-Summerson photometer (no. 66 red filter — 640-700 m/x.) with 
the blank set at zero. 

Measured quantities (0.2 mg./40 ml.) of various phenolic compounds were ex- 
tracted individually, first at pH 8, 9, or 10, respectively, and then at pH 1, and the 
extracts were analyzed as outlined above with the Folin-Ciocalteau reagents. The 
data are given in Table 1. Satisfactory recovery values are indicated, except for 
resorcinol and catechol which are unstable in alkaline solution. When known mixtures 
of p-cresol and p-hydroxyphenylacetic acid were extracted at pH 10 and pH 1, recov- 
ery values ranged from 95-102 per cent. During extraction of alkalinized urine 
hydrolysates, volatile phenols may circulate between the receiver and the extraction 
tube (10). Although volatile phenols can be fixed in the receiver with dilute sodium 
hydroxide, this procedure causes lower values when rat urine is extracted. 

The values for the phenol fraction were obtained from a standard curv^e developed 
with the Folin-Ciocalteau reagent from solutions of phenol-p-cresol prepared by ap- 
propriate dilution of a stock solution containing 10 mg. of phenol and 40 mg. of p- 
cresol per 100 ml. The values for the aromatic hydroxy acid fraction were obtained in 
a similar manner from a stock solution containing 16.67 mg. of p-hydroxybenzoic and 
50 mg. of p-hydroxyphenylacetic acid per 100 ml. These mixtures were used since the 
colors they gave wath diazotized p-nitroaniline matched the colors obtained with this 
reagent on urine extracts (7, 11). 



SCHMIDT ET AL.— ANTIBIOTICS AND RAT URINE 

TABLE 2 
Ejffecl of Feeding Cfdorletracycline Hydrochloride on the Nitrogenous and Phenolic Constituents 

of Rat Urine* 



Dates 


Brug 


Phenols 


Aromatic Hydroxy 
Acids 


Amino Acid Nitrogen 


Am- 
monia 
Nitro- 
gen 


Total 
Nitro- 
gen 


Folin- 

Ciocalteau 

reagent 


Diazotized 

p-nitroani- 

line 


Folin- 

Ciocalteau 

reagent 


Diazotized 

p-nitroani- 

line 


Copper 
method 


Sahyun 
method 


Russell 
modifica- 
tion 


2/2-4 

4-6 

7-9 

9-11 

11-13 

14-16 

16-18 

18-20 

23-25 

25-27 

27-29 


mg. '"c 








10 
10 
10 
10 
10 
10 
10 


13.2 

13.1 

12.0 

14.3 

10.2 

6.1 

6.9 

7.7 

9.9 

9.8 

10.0 


10.0 
9.8 

11.0 

5.1 

5.3 
7.1 

8.0 


14.1 
14.6 
14.2 
12.7 
11.1 
12.0 
13.6 
13.5 
19.4 
15.5 
17.2 


12.9 

10.4 

12.5 

13.8 
15.0 
13.0 
15.9 


28.3 
34.5 
35.6 
30.9 
29.6 
30.1 
27.8 
27.7 
33.8 
28.5 
31.0 


17.4 
20.0 
17.1 
16.1 
16.3 
20.8 
22.2 
20.0 
19.5 


17.8 
20.0 
18.5 
16.5 
16.6 
20.8 
22.6 
20.5 
21.3 


53 
87 
81 
56 
69 
68 
40 
62 
64 


1678 

1631 
1608 
1553 
1634 
1598 
1712 
1445 
1811 



* Diet consisted of 56 gm. Hunt Clul) Lab Ghow/2 rats/48 hours. Analytic values are expressed 
as nig./2 rats/48 hours; phenols as phenol-p-cresol (1:4) and aromatic hydroxy acids as p-hydroxy- 
benzoic-p-hydro.xyphenylacetic acid (1:3); amino acid, ammonia, and total nitrogen as mg. of 
nitrogen. 



TABLE 3 

Effect of Feeding Bacitracin on the N ilrogenous and Phenolic Constituents of Rat Urine* 





Drug 


Phenols 

Folin- 

Ciocalteau 

Reagent 


Aromatic 

Hydro.\'y 

Acids 

Folin- 

Ciocalteau 

Reagent 


Amino Acid Nitrogen 


Ammonia 
Nitrogen 


Total 


Dates 


Copper 
method 


Sahyun 
method 


Russell 
modifica- 
tion 


Nitrogen 




mg. % 
















10/18-20 





10.0 


11.2 


26.9 


16.3 


16.3 


60 


1179 


20-22 





8.5 


13.0 


28.0 


17.0 


17.3 


70 


1289 


24-26 


10 


8.7 


12.8 


— 


— 


— 


— 


1214 


26-28 


10 


10.9 


15.3 


25.1 


16.0 


15.8 


63 


1256 


28-30 


40 


7.8 


10.0 


— 


— 


— 


— 


1289 


31-11/2 


40 


12.0 


10.4 


28.2 


18.1 


17.1 


55 


1265 


11/2-4 


40 


13.0 


13.0 


25.7 


16.9 


16.6 


67 


1256 


4-6 


40 


10.2 


14.1 


— 


— 


— 


— 


— 


7-9 


40 


11.3 


13.4 


28.0 


17.1 


16.8 


70 


1445 


9-11 





12.7 


15.8 


— 


— 


— 


— 


1471 


11-13 





11.3 


12.8 


25.5 


16.2 


15.3 


66 


1428 
1420 



* Diet consisted of 52 gm. Hunt Club Cho\v/2 rats/48 hours. Analytic values are expressed as 
mg./2 rats/48 hours; phenols as phenol-p-cresol (1:4) and aromatic hydroxy acids as p-hydroxy- 
benzoic-p-hydroxyphenylacetic acid (1:3); amino acid, ammonia and total nitrogen as mg. of 
nitrogen. 



10 



BULLET I y OF THE SCHOOL OE MEDICINE, U. OF MD. 



Ten 5 ml. aliquols of a sample of rat urine were analyzed. Standard deviation for 
the phenol-p-cresol fraction was ±0.62vS, per cent standard deviation ±5.75; the 
aromatic acid fraction was ±0.62 and ±5.80, respectively. The addition of 3-nilro-4- 
hydroxyphenylarsonic acid, chlortetracyline hydrochloride or bacitracin to urine did 
not interfere with any of the analytical procedures. 



RESULTS AND CONCLUSIONS 

The analytical data obtained in the experiments with diets supplemented with 
chlortetracycline and bacitracin are given in Tables 2 and -S. Since the results ob- 
tained with 3-nitro-4-hydroxyphenylarsonic acid were essentially negative, detailed 
data have been omitted. Amino acid nitrogen values by the copper method were 
somewhat higher than those obtained with the Sahyun (5) and Russell (6) methods 
on urines which were made ammonia-free by aeration. The latter two methods, how- 
ever, gave almost identical values. 

The averaged data (mg. nitrogen per 2 rats per 48 hours) summarized below def- 
initely show that ingestion of chow supplemented with these chemotherapeutic 
compounds did not influence significantly amino acid nitrogen, ammonia, or total 
nitrogen levels in the urine: 





Drug in Feed 


Mg. % 


No. of 

Urines 

Analyzed 


Amino Acid Nitrogen 


Ammonia 
Nitrogen 


Total 




Copper 
method 


Sahyun 
method 


Russell 
method 


Nitrogen 


A 


Chlortetracycline 





4 


32.8 


17.7 


19.8 


69 


1618 




hydrochloride 


10 


10 


30.0 


19.8 


20.4 


61 


1640 


B 


Bacitracin 





2 


27.4 


16.6 


16.8 


65 


1234 






40 


7 


27.0 


17.0 


16.6 


64 


1314 


C 


3-Nitro-4-hydroxy- 





3 


19.3 


16.7 


16.7 


35 


1299 




phenylarsonic acid 


10 


10 


17.8 


16.8 


16.8 


37 


1328 



It is obvious that ingestion of these drugs in Lab Chow complete in all essential 
dietary elements did not produce a decrease in amino acid nitrogen, ammonia, or 
total nitrogen excretion. This effect could be expected if growth stimulation had 
occurred. Our data are in accordance with the concept that growth stimulation in the 
rat by antibiotics does not usually occur unless a vitamin is lacking from an otherwise 
complete diet. 

Values for the phenolic and aromatic hydroxy acid fractions by the two methods 
ran parallel although the diazotized p-nitroaniline procedure generally gave slightly 
lower values than those obtained with the Folin-Ciocalteau reagents. The ingestion of 
bacitracin and 3-nitro-4-hydroxyphenylarsonic acid did not influence materially the 
rate of formation and excretion of volatile phenols or aromatic hydroxy acids. How- 
ever, the addition of 10 mg. per cent of chlortetracycline hydrochloride to the diet 
produced a marked reduction in urinary volatile phenols — the average level dropped 
from 13.2 to a minimum of 6.1 mg. phenol-p-cresol (1:4) per 2 rats per 48 hours, as 
measured by the Folin-Ciocalteau reagent, in 6 days. This decrease was relatively 



SCHMIDT ET AL— ANTIBIOTICS AND RAT URINE 11 

transient, however, and formation and excretion of the volatile phenols returned to 
normal levels within 12 days after drug ingestion had been instituted. 

A significant change in the excretory level of the aromatic hydroxy acid fraction, 
however, was not observed. Thus the average values before and during chlortetra- 
cycline feeding were: high 14.6, low 12.7, average 13.9; and high 19.4, low 11.1, 
average 14.7 mg. of p-hydroxybenzoic-p-hydrozyphenyl-acetic acid (1:3), respec- 
tively. Similar results were obtained with this antibiotic in a second experiment 
(data omitted). 

Since these compounds gave different results in regard to the volatile phenols, it 
seems probable that each antibiotic exerts its own specific effect on the microflora 
concerned with intestinal putrefaction. Whether this is true in such species as the 
weanling pig turkey poult, chick, etc., where growth rate responds favorably to anti- 
biotic supplementation, even in case of complete, adequate diets, remains to be 
ascertained. 

SUMMARY 

The addition of chlortetracycline hydrochloride, bactracin, or 3-nitro-4-hydrox- 
yphenylarsonic acid to the diet of rats did not alter significantly the amount of 
amino acid nitrogen, ammonia, total nitrogen, or the ether-soluble aromatic hydroxy 
acid fraction excreted in the urine. Only chlortetracycline hydrochloride fed at the 10 
mg. per cent level produced a marked decrease in the formation and excretion of 
volatile phenols. This effect, however, was transient, and the formation and excretion 
of the compounds making up this fraction returned to normal levels within 12 days. 

BIBLIOGRAPHY 

1. Stokstad, E. L. R.: Antibiotics in animal nutrition, Antibiotics and Chemother., 3: 434-441, 

1952. 

2. Sauberlich, H. E., and Baumann, C. A.: The effect of dietarj^ protein upon amino acid excre 

tion by rats and mice, J. Biol. Chem., 166: 417-428, 1946. 

3. Albanese, A. A., and Irby, V.: Determination of amino nitrogen by the copper method, J. 

Biol. Chem., 153: 583-588, 1944. 

4. Harrow, B., Wagreich, H., and Majur, A.: Laboratory Manual of Biochemistry, 3rd. Ed., 

W. B. Saunders Company, 1950. 

5. Sahyun, M.: The determination of amino acid nitrogen in blood and urine, J. Lab. Clin. Med., 

24: 548-553, 1939. 

6. Russell, J. A.: Note on the colorimetric determination of amino nitrogen, J. Biol. Chem., 156: 

467-468, 1944. 

7. Schmidt, E. G.: An ether extraction method for the determination of urine phenols, J. Biol. 

Chem., 145: 533-544, 1942. 

8. Schmidt, E. G., McElvain, N. F., and Bowen, J. J.: Am. J. Clin. Path., 20: 253-261, 1950. 

9. FoLiN, O., and Ciocalteau, v.: On tyrosine and tryptophane determinations in proteins, J. 

Biol. Chem., 73: 627-650, 1927. 

10. DeMeio, R. H.: .\ microextraction procedure for phenol determination. Science 108: 391-393, 

1948. 

11. ScHMroT, E. G.: Urinary Phenols. IV. Simultaneous determination of phenol and p-cresol in 

urine, J. Biol. Chem., 179: 211-215, 1949. 

12. Banker, J. L., and Schmidt, E. G.: Urinary Phenols. III. Effect of diet and phthalysulfathiazole 

on the urinary phenols of the dog, J. Biol. Chem., 165: 431-435, 1946. 



EKFECT OF FEEDING ETHER EXTRAC TS OF HYDROLYZED HUMAN 
URINE ON GROWING RATS*t 

Gerald KesslerJ, Th.D., K. G. Schmidt, Ph.D., .\nd R. E. Vanderlinde, Ph.D 

The growlli-promolinj^ effect of feeding aiuibiolics may be correlated with their 
inlluence on the intestinal flora although the exact mode of action remains uncertain. 
In our laboratory Kessler (1) found that the excretion of urinary phenols by the rat 
may be decreased and hydroxyaromatic acids increased by the feeding of certain 
antibiotics. It seems possible that the stimulatory effect antibiotics exert on the 
pituitary-adrenal system may be related to this change in the concentration of these 
ether-soluble urinary constituents. Aspirin and related hydroxyaromatic acids can 
act in this manner (2). 

Since the literature failed to yield any pertinent data as to the effect of the addition 
of ether extracts of hydrolyzed human urine to the diet of growing animals, and since 
this information would be essential for further experimentations in this field, the 
following experiment was performed. 

EXPERIMENT.\L PROCEDURE 

A 24-hour specimen of human urine was adjusted to pH with sulfuric acid and 
open-heated on a steam bath for 5 hours. The hydrolysate was changed to pH 10 with 
sodium hydroxide and extracted continuously with freshly distilled ether until a test 
sample of the extract was phenol-free. This extract which contained volatile phenols 
and neutral materials was discarded. The residue was adjusted to pH 1 with sulfuric 
acid and again extracted continuously (3) until free of hydroxyaromatic acids. Water 
was added to the extract, the ether volatilized and the aqueous residue again extracted 
at pH 10 and 1. Five 24-hour specimens of human urine (male and female, about 6000 
ml.) were treated in this manner. 

This pooled ether extract was assayed (4) for its content of phenolic acids and then 
sprayed onto pulverized Hunt Club Lab Chow at a level of 80 mg. of phenolic acid 
(calculated as p-hydroxyphenylacetic acid) per 100 gm of feed. The ether was allowed 
to evaporate and the feed then thoroughly mixed. The control feed was treated 
similarly with freshly distilled ether. Sprague-Dawley female rats were housed in 
individual cages. Food and water were given ad libitum for 14 days, and the rats were 
weighed twice weekly. Experimental details are described elsewhere (5). 

RESULTS AND DISCUSSION 

For the 6 control rats the average initial weight was 125.5 gm. (±2.11), final 
weight 167.7 gm. (±2.34) and weight gain 42.2 gm. (±1.35) (figures in parentheses 

Received for publication September 26, 1956. 

* From the Department of Biological Chemistry, School of Medicine, University of Maryland, 
Baltimore 1. Maryland. 

t This investigation was supported (in part) by a grant from the Division of Research Grants 
and Fellowships of the National Institutes of Health, U. S. Public Health Service. 

I .\li)ert Einstein Medical Center, Philadelphia 41, Pennsylvania. 

12 



KESSLER ET AL— FEEDING EXPERIMENTS WITH RATS 13 

are standard error of the mean). Total feed consumed average 194 gm. (±2.38) and 
the feed efficiency value (total feed consumption divided by total weight gain) aver- 
aged 4.61 (dz0.15). For the 6 rats on the supplemented diet the average initial weight 
was 126 gm. (±1.16), final weight 160.8 gm. (±2.24) and weight gain 34.8 gm. 
(±1.76). Total feed consumed averaged 186.7 gm. (±1.50), and the feed efficiency 
value 5.36 (±0.25). 

The average difference in total weight gain between the control and experimental 
rats is —7.4 gm. or —12.3%; the corresponding average difference in feed efficiency 
values is —0.75 or —16.3%. These values are statistically significant by the "t test" 
and show that the ether-soluble acid fraction of hydrolyzed human urine was slightly 
toxic to growing rats. This influence on growth and food consumption may represent 
the ultimate effect of growth stimulatory and inhibitory factors present in the ether 
extract. 

SUMMARY 

An ether extract of hydrolyzed human urine, free from volatile phenols but con- 
taining a mixture of aromatic and other organic acids, was slightly toxic when fed to 
growing rats. 

BIBLIOGRAPHY 

1. Kessler, G.: EtYccts of chciTiothera|)eutic agents on growth, urinary phenols, and aromatic 

acids. Univ. Microfilms (Ann .\rl)or, Mich.) Publ. No. 11, 886; Dissertation Abstr., 15: 845, 
1955. 

2. Cronheim, G., King, J. S., Jr., axd Hvder, N.: Effect of salicjlic acid and similar compounds 

on the adrenal-pituitary system, Proc. Soc. Exper. Biol. & Med., 80: 51-55, 1952. 

3. Schmidt, E. G. : Urinarj^ phenols, IV. The simultaneous determination of phenol and p-cresol 

in urine, J. Biol. Chem., 179: 211-215, 1949. 

4. Schmidt, E. G., McElvain, N., and Bowen, J. J.: Plasma amino acids and ether-soluble phenols 

in uremia, Am. J. Clin. Path., 20: 253-261, 1950. 

5. Kessler, G., Vanderlinde, R. E., and Schmidt, E. G.: Effect of 3-nitro-4-hydroxyphenylarsonic 

acid on growth of rats, .\ntibiotics & Chemother., 4: 511-513, 1953. 



A.MODIOgUIN (CAMOQUIN) L\ THE TREATMENT OF DISCOID LUPUS 

ERYTHEMATOSUS 

RAYMOND C. V. ROBINSON, M.D., HARRY M. ROBINSON, JR., M.D., 
AND JOHN F. STRAHAN, M.D. 

The mode of action of anti-malarial drugs in discoid lupus erythematosus is obscure, 
but the therapeutic efficacy of these compounds has been established. Since 1951, 
when Page (1) reported his observations on the use of mepacrine (Atabrine®), many 
articles have been published attesting to the value of quinacrine (2-5), chloroquine 
(6-9), and plaquenil (10). 

One of the major objections to mepacrine (Atabrine) therapy is the deposition of 
yellow pigment in the skin and the occasional development of a lichenoid eruption 
which simulates lichen planus (11). One instance of fatal aplastic anemia following 
the use of mepacrine has been reported (12). Disturbances of the hemopoietic system 
and porophyria (13) have been noted during the administration of chloroquine for 
discoid lupus erythematosus. These reactions, among others, have led to the use of 
amodioquin (Camoquin®) and anti-malarial drugs, in the treatment of discoid lupus 
erythematosus. During preliminary trials amodioquin appeared to be of some value 
(14). This report concerns the experiences of the authors with orally administered 
amodioquin in the treatment of 22 patients with discoid lupus erythematosus. 

THE STUDY 

Patient Selection: The patients in this study were all adults, ranging in age from 
26 to 45 years. They included 6 white men, 4 negro males, 8 white women and 4 
Negro women. Patients were obtained from the authors' private practices and the 
out-patient department of the University Hospital. Three patients stated that lesions 
had been present for less than a year, 6 had lesions for 1 to 4 years, and 13 stated the 
eruption had been present for more than 5 years. None of the patients had received 
gold therapy during the past 5 years, but 3 had been treated with intramuscular 
bismuth subsalicylate during this period. Of the 9 patients who had taken other anti- 
malarial drugs, three had not responded to quinacrine but had received some benefit 
from chloroquine. Eight patients benefitted to some extent from one or another of 
these medications, but suffered exacerbations of the eruption after discontinuing 
medication. 

The Drug: Amodioquin (Camoquin®) used in this study was supplied in the form 
of 0.2 gram scored compressed tablets for oral administration. 

Method: In the authors' opinion discoid lupus erythematosus and systemic lupus 
erythematosus are variants of the same disease complex, therefore, the diagnosis of 
discoid lupus erythematosus was established in each of the patients included in this 
report by laboratory studies. These routine studies included histopathologic findings, 
blood studies, examination for L. E. cell phenomenon, and albumin-globulin ratio. 

From the Division of Dermatology Department of Medicine, University of Maryland School of 
Medicine. 

14 



ROBINSON ET AL.~DISCOID LUPUS ERYTHEMATOSUS 



15 



TABLE 1 

Twenty-Two Adults with Discoid Lupus Erythematosus, Treated with Amodioquin (Camoqtiin) 

for 5 to 18 Weeks 



Duration 


No. 

Patients 


Previous Therapy 


Results of Treatment with 
Amodioquin 


Adverse Reaction 




Good 


Fair 


Failure 




3 to 12 months 

1 to 4 years 

5 years or longer 


3 

6 

13 


None, or other 
anti-malarial 
drugs 

Other anti-mala- 
rial drugs, gold, 
bismuth 

Other antimalarial 
drugs, gold, bis- 
muth 


3* 

4t 
8t 


None 
2 

5 


None 
None 
None 


None 

Slight vertigo (one 
patient) 

Slight vertigo (one 
patient) 



* Objective improvement in all lesions with macroscopic disappearance of small or recent lesions, 
t Objective improvement with reduction in erythema and size of lesions. 

Patients were observed at weekly intervals. Notation of objective changes were 
made and patients were questioned as to subjective symptoms. Hematologic studies 
and urinalyses were done monthly to determine any possible adverse reaction. 

Dosage Schedule: Each patient received 0.2 gram amodioquin 3 times daily after 
meals for 2 weeks, then 0.2 gram twice daily. Duration of therapy ranged from 8 to 
54 weeks. 

RESULTS 

(See Table 1) 

Improvement in all lesions and complete macroscopic involution of some smaller 
or recent lesions was noted in 15 of the 22 patients. Reduction in erythema and in the 
size of the lesions was observed in 7 patients treated with amodioquin. Complete 
macroscopic involution of lesions did not occur in any of these 7 patients. In all in- 
stances the atrophic scar formation was persistent. 

Reactions: Two patient complained of slight giddiness while taking the drugs. No 
hematologic disturbances were encountered, nor were other untoward reactions noted. 



SUMMARY AND CONCLUSIONS 

Twenty-two adults with discoid lupus erythematosus were treated with amodioquin 
for 8 to 54 weeks. 

Partial involution of lesions was noted in 7 patients, and almost complete involu- 
tion of lesions was noted in 15 patients. 

No serious adverse reactions were noted during the period of amodioquin treat- 
ment. 

Amodioquin (Camoquin®) is an effective drug in the treatment of discoid lupus 
erythematosus. 



16 BULLETIN OF THE SCHOOL OF MF.niCINE, U. OF MD. 

BIBLIOGRAPHY 

1. Page, F.: Treatment of lupus erythematosus with mepacrine, Lancet 2: 755-758 (Oct. 27) 1951. 

2. Cramer, J. A. akd Lewis, G. M.: Atabrine in treatment of discoid lupus erythematosus, J. 

Invest. Dermat. 19: 393-395 (Dec.) 1952. 

3. Sawicky, H. H.; Kanof, N. B., Silverbert, M. G., Braitman, M. and Kalish, B.: Quinacrine 

hydrochloride (Atabrine Hydrochloride) for chronic discoid lupus erythematosus. J. Invest. 
Dermal. 19: 397-404 (Dec.) 1952. 

4. Wells, G. C: Treatment of chronic discoid lupus crjthematosus with .\tabrine, J. Invest. 

Dermat. 19: 405-407 (Dec.) 1952. 

5. SoMMERViLLE, J.; Devine, D. C. and Logan, J. C. P.: Lupus erythematosus treated with 

mepacrine. Brit. J. Dermat. 64: 417-419 (Nov.) 1952. 

6. Goldman, L.; Cole, D. P. and Preston, R. H.: Chloroquine diphosphate in treatment of 

discoid lupus erythematosus, J.A.M.A. 152: 1428-1429 (Aug. 8), 1953. 

7. H.VRVEY, G. and Cochrane, T.; Treatment of lupus erythematosus with chloroquine Sulfate, 

J. Invest. Dermat. 22: 89-91 (Feb.), 1954. 

8. Prakken, J. R. AND MoLHUYSEN - van der Walle, S. M. C: Treatment of chronic lupus erythem- 

atosus with chloroquine, Dermatologica 108: 198-201 (March), 1954. 

9. Rogers, J. and Finn, O. A.: Synthetic antimalarial drugs in chronic discoid lupus erythematosus 

and light eruptions, A. M. A. Arch. Dermat. & Syph. 70: 61-66 (July) 1954. 

10. CoRNBLEET, T. : Discoid lupus er3'thematosus treated with plaquenil, A. M. A. Arch. Dermat. 

& Syph. 73: 572-575 (June) 1956. 

11. Bazemore, J. M.; Johnson, H. H.; S\v.\nson, E. R. and Haytu.a.n, J. M.: Relation of quinacrine 

hydrochloride to lichenoid dermatitis (Atypical lichen planus) Arch. Dermat. & Syph. 54: 
308-324 (Sept.) 1946. 

12. Parmer, L. G. and S.\witsky, A.: Fatal aplastic anemia following quinacrine therapy in chronic 

discoid lupus erythematosus, J. A. M. A. 153: 1172-1174 (Nov. 28) 1953. 

13. Linden, I. H.; Steffen, C. G.; Newcomer, V. and Chapman, M.: Development of porphyria 

during chloroquine therap}^ for chronic discoid lupus erythematosus, California Med. 81: 
235-238 (Sept.) 1954. 

14. Leeper, R. W. and Allende, M. F.: Antimalarials in the treatment of discoid lupus erythema- 

tosus. A. M. A. Arch. Dermat. & Syph. 73: 50-57 (Jan.) 1956. 



SESQUICENTENNIAL YEAR 

1807-1957 



Bulletin of 



THE SCHOOL OF MEDICINE 

UNIVERSITY OF MARYLAND 

VOLUME 42 Aprilj 1957 NUMBER 2 

(Special Article) 

THE SURGERY OF DUODENAL ULCER* 

HENRY N. HARKINS, M.D., Pn.D.f 

PROFESSOR OF SURGERY, UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE 

The surgery for any clinical condition involves the past, the present, and predic- 
tions for the future. This is indeed true for duodenal ulcer. 

The history of the surgery of duodenal ulcer is essentially that of the last 75 years. 
The advent of antisepsis with Lister in 1867 enabled surgeons to explore the peri- 
toneal cavity and within 14 years, peptic ulcer w^as being treated surgically by 
gastrojejunostomy as introduced by Wolfler in 1881 (X.B., also 14 years before 
Rontgen). While gastric resection was introduced by Billroth in 1881 (Billroth I: 
resection with gastroduodenal anastomosis) and in 1885 (Billroth II: resection with 
gastrojejunal anastomosis), such resections were first for gastric carcinoma, later 
for gastric ulcer, and only in 1915 (von Haberer in Germany and Strauss in Chicago) 
was gastric resection introduced for the treatment of duodenal ulcer. Although gas- 
tric resection was quickly adopted for this purpose by the German surgeons, gastro- 
jejunostomy w^as the method of choice in almost all of the American clinics until 
at least 1925 and in some eastern institutions until 1940. During the decade 1930- 
1940, therefore, gastric resection was the operation of choice in all but the most 
reactionary of the better clinics in this Country and in almost all European clinics 
for the surgical treatment of duodenal ulcer. Such resections in this Country almost 
invariably were ad modiim Billroth II; in Europe some were also ad modmn Bill- 
roth I. 

In 1942, vagotomy was introduced by Dragstedt of Chicago. It is true that va- 
gotomy had been done by others but such earlier vagotomies were incomplete (e.g., 
at the level of the pylorus) or were in the neck, affecting the heart as well as the 
stomach. Soon vagotomy was combined with gastrojejunostomy (Dragstedt) and 
later with pyloplasty (Weinberg, of Long Beach). 

* Received for publication January 15, 1957. 

t Dcpl. Surgery, I'niv. of Washington School of Medicine, Seattle 5. Washington. 

17 



18 BULLETIN OF THE SCHOOL OF MEDICINE. U. OF MD. 

More recently, Wangensteen, of Minneapolis, introduced an operation involving 
wedge resection of the corpus, leaving the antrum intact, but reanastomosing the 
upper stump of the corpus to it in continuity and performing a pyloroplasty for 
drainage. The pyloroplasty is necessary because while the remaining corpus is not 
vagotomized, the antrum is vagally denervated because of the resection above. 
Such a corpal wedge resection with pyloroplasty we have termed the Wangensteen 
I. Soon afterwards, Wangensteen introduced the Wangensteen II (longitudinal tubu- 
lar resection with transverse gastroplasty, i.e., resection of the greater curvature fol- 
lowed by transverse closure of the defect). In 1956, Wangensteen stated that he 
had abandoned the II and had reverted to the Wangensteen I. 

Another trend, beginning after the second World War, was the reintroduction in 
this Country of the Billroth I in preference to the Billroth II for the surgical treat- 
ment of duodenal ulcer. The I was originally abandoned by Billroth because of 
leakage at the fatal angle, or "Jammerecke", and later by most of those who tried 
it in this Country because of a high incidence of stomal ulcer. The present day advo- 
cates of the Billroth I believe, however, that both of these difficulties can be ob- 
viated; the former by modern suture technics and the latter by a combination of 
(a) mobilization of the duodenum (introduced by Kocker in 1903), (b) adequate 
gastric resection measured quantitatively by patterns or other such means, and (c) 
by utilization of the Finney-von Haberer end-to-side gastroduodenostomy after resec- 
tion when the duodenum is markedly indurated, closing the duodenal stump as 
with a Billroth II in such instances. 

The situation at present is, therefore, much more complicated than it was 20 
years ago when gastric resection ad mochim Billroth II was almost unopposed as the 
operation of choice for the surgical treatment of duodenal ulcer. Now at least 4 
other procedures have strong supporters advocating their advantages: (1) Vagotomy 
with either gastrojejunostomy or pyloroplasty, (2) Gastric resection ad modiini 
Billroth I, (3) Wedge resection of the corpus with pyloroplasty ad modum Wangen- 
steen I, and (4) Hemigastrectomy combined with vagotomy. 

It should be pointed out at this time that while there is argument as to which 
operation is the one of choice, there is no argument that in the majority of cases of 
duodenal ulcer medical treatment is preferable to any operation. Surgical treatment 
is still advised only for the four main complications of duodenal ulcer: obstruction, 
perforation, massive or continued hemorrhage, and intractability to or incompati- 
bility with good medical treatment. Fortunately, the problem of malignant change 
is not of practical importance in duodenal ulcer as it is in the case of gastric ulcer. 

The current problem of surgery for perforated duodenal ulcer, like that of duo- 
denal ulcer in general, is not as simple as it was a few years ago. In 1947, simple 
closure with an omental tag was the treatment of choice in this Country. This was 
true despite the fact that the first successful operation for perforated ulcer was a 
primary gastric resection (Billroth I) by Keetley in 1902, that von Haberer in 1919 
advocated primary resection as the method of choice, and that von Haberer's ad- 
vice has been followed ever since in the majority of eastern European clinics. In 
1957, however,, in the United States, simple closure, while still the treatment of 
choice, does not hold the field unopposed, as there are strong advocates for primary 



HARK INS— SURGERY OF DUODENAL ULCER 19 

gastric resection and for continuous gastric suction. As to which of these 3 methods 
will win out in the future, no prognostication will be made at this time. 

The future of surgery for duodenal ulcer in general, not just perforation, is diffi- 
cult to forecast. New knowledge obtained from the experimental laboratory (it is 
of interest that while 30 years ago almost all work on gastric physiology was done 
in physiology departments, now the major portion is done in clinical departments) 
has influenced our thinking. From the multitude of experimental observations with 
possible practical application, only three will be mentioned: (1) Confirmation of 
Edkins' observations (1906) that an antral secretory hormone (gastrin) exists, (2) 
Observation of a hormonally stimulatory effect of gastrojejunostomy on gastric acid 
secretion, and (3) Determination of a compound opposing effect in the use of two 
experimental preparations, viz. : (a) vagotomy decreases acid secretion directly, but 
at the same time stimulates the hormonal phase of such secretion, and (b) the an- 
trum is stimulated to form gastrin by contact with food, but acid secretion of the 
parietal cells of the corpus is inhibited when acid contacts the antrum: hence, the 
behavior of the antrum is quite different when in continuity than when not. 

The observation from clinical studies is germane to the discussion that even though 
dumping may be less serious following the Billroth I than the Billroth II, it is still 
troublesome after either. While not all surgeons would agree that the incidence of 
dumping is proportional to the extent of resection, the weight of evidence available 
at present would seem to support this view. At the same time all surgeons would 
agree that the incidence of stomal ulcer is generally proportional to the amount of 
acid secreting stomach left intact after resection. Thus, the use of the Billroth resec- 
tions must traverse a difficult course between the Scylla of inadequate resection with 
its danger of recurrent ulcer and the Charybdis of extensive resection and its at- 
tendant high incidence of unpleasant dumping symptoms. 

For all these reasons, the future of surgery for duodenal ulcer may show new 
trends. The Billroth operations may lose their popularity. An operation leaving the 
antrum intact, but also in continuity with the stomach remnant may become the 
fashion. Vagotomy combined with conservative resection may prove to be the best 
procedure. On the other hand, some new operation or medical treatment, hitherto 
undreamed of, may be found to be superior. The future is difficult to forecast, how- 
ever, and one hesitates to place himself in the position of Stephen Puget, who speak- 
ing of cardiac surgery in 1896, stated that "Surgery of the heart has probably 
reached the limits set by nature to all surgery; no new method and no new dis- 
covery can overcome the natural difficulties." 



CO^rPARAl IVE SERUM AND CEREBROSPINAL ELUID 

TRANSAMINASE LEVELS IN ACUTE 

CEREBRO VASCULAR DISORDERS* 

MOTOJI MIYAZAKI, M.D.f 

INTRODUCTION 

Glutamic oxalacetic transaminase (GOT) is widely distributed in animal tissues; 
being present in heart muscles, skeletal muscles, brain, liver, kidney, testis and lung 
in decreasing order (1, 2). The absence of an increase in serum transaminase activity 
in the presence of central nervous system disease has been attributed to the blood 
brain barrier (3). Recently, Wakim and Fleisher have reported a marked increase of 
cerebrospinal fluid transaminase, as well as some increase in serum transaminase in 
experimental cerebral infarction in dogs (4). 

It is the purpose of this article to report cerebrospinal fluid (CSF) and serum 
transaminase activity in acute cerebrovascular disease and to compare these findings 
with other miscellaneous neurologic diseases, as well as a few observations of such 
activity in brain tumor patients and patients with acute liver damage. 

METHOD 

The determinations were made spectrophotometrically by the method outlined 
by Karmen (5). Specimens were stored in a frozen state and were measured within 
a week after being obtained. Examinations were carried out at room temperature, 
(25C). Serum and CSF were tested from 20 patients with actue cerebrovascular 
lesions and 3 patients with acute liver damage. In addition, 5 proved and 2 suspected 
brain tumor cases were so tested. 

TABLE 1 

GOT Activity in Serum and CSF Among Control Groups 



Serum 
CSF 



No. of Subjects 



10 
30 



Mean, Standard Deviation 
& Range (units) 



28.9 ± 4.4 (22-36) 
16.8 ± 7.6 (2-30) 



Miscellaneous neurologic diseases included 8 patients with old cerebrovascular 
accidents, 7 with convulsive disorders, 2 with bacterial meningitis, 2 with tabes dor- 
salis, 2 with organic psychosis, 2 with hypertensive encephalopathy, and 1 in each 
of the following diseases: old subarachnoid hemorrhage resulting from aneurysmal 
rupture, pseudotumor cerebri, multiple sclerosis, Parkinson's disease, trigeminal 
neuralgia, acute porphyuria and congenital hydrocephalus. 

* Received for publication December 20, 1956. 

t From the Division of Neurology, Department of Medicine, University of IMar_\-Iand. 

Note: Supported in part by U. S. Public Health Research Grant B-797. 

20 



MIVAZAKISERUM AND CEREBROSPINAL FLUID LEVELS 



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BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 



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BVLLETIX OF THE SCHOOL OF MEDICIXE, U. OF MD. 



CONTROL OBSERVATIONS 

Control values for serum GOT were based on 10 normal volunteers. The controls 
for CSF GOT were 30 pjatients (average age 55) with no neurologic or systemic 
disease who were about to receive spinal anesthesia. 

RESULTS 

Mean values and standard de\-ialions among controls were 28.9 ± 4.-4 u. for 
serum and 16.8 ± 7.6 u. for CSF (Table 1). Serum GOT levels were higher than 
normal in more than half of the cases with acute cerebrovascular lesions during the 
first five days following the onset of the illness. The greatest values appeared a few 
days after the onset. There was little difference whether the samples were obtained 
from the internal jugular veins or the extremity veins (Table 2). 

Of 20 patients with acute cerebrovascular accidents, 8 showed definite elevation 
of CSF GOT, 5 were in upper limits of normal and 7 showed no elevation. The 
greatest elevation appeared within 120 hours after the onset of the illness (Table 2). 

Samples from 7 patients with either proved or susf)ected brain ttmaors showed no 
elevation of CSF GOT except the one of suspected third ventricular tumor, with 
internal hydrocephalus demonstrated by air study (Table 3). Three patients with 
van.-ing tN^pes of liver disease all showed elevated serum GOT and normal CSF levels 
(Table 4), apparently demonstrating the role of the blood brain barrier. The reverse 
situation is demonstrated with patients Xo. 1,8, and 15 of Table 2 with normal senmi 
GOT and elevated CSF levels. Among miscellaneous neurologic diseases most of them 



T-\BLE 3 
Brain Tumor Patients 



Serum GOT* 



CSF GOT* 



Proved 

Glioma 

3rd ventricular Tumor 

Glioma 

Glioma 

Glioma 

Suspected 

3rd Ventricular Tumor with Hjdrocephalus 
3rd Ventricular Timior 

* Units 



38 
40 
38 



16 
28 
22 
12 

10 



44 



62 
10 



TABLE 4 
Serum and Cerebrospinal Fluid Levds {Units) In Patients With Liver Disease 



Clinical Diagnosis 



Serum GOT 



CSF GOT 



1. Histoplasmosis 

2. Sarcoidosis 

3. Infectious hepatitis 




MIYAZAKI— SERUM AXD CEREBROSPIXAL FLUID LEVELS 



TABLE 5 
Cerebrospinal Fluid GOT Levels Among Miscellaneous Types of Xeurologic Diseases 



Clinical Diagnosis 



CSF 
GOT 



1) Old Cerebrovascular Accidents 
Unilateral: 



Bilateral : 



2) Convulsive Disorders 
Grand Mai: 



5 hours after the end of status epi- 

lepticus 
72 hours later 
2 hours after the end of status epi- 

lepticus 
Psychomotor: 

3) Meningitis, bacterial 

4) Tabes dorsalis 

5) Organic Psychosis 

6) Hypertensive Encephalopathy 

7) Old subarachnoid hemorrhage due to 
rupture of aneurysm i2 weeks after 
onset) 



Clinical Diagnosis 



CSF 
GOT 



8) Pseudotumor cerebri 4 

9) Multiple sclerosis in exacerbation 16 
lOj Parkinson's Disease 2 

11) Trigeminal neuralgia 8 

12) Acute Porph>-uria 18 

13) Congenital Hydrocephalus 96 



18 
28 
24 
26 
8 
10 
24 
26 

5 
18 

8 
10 

40 

20 
30 

12 
2 

18 
31 
30 
24 
22 
I 
30 
20 



showed normal CSF GOT levels. Interesting results were seen in 1 patient with con- 
genital hydrocephalus which showed marked elevation and 2 cases of status epilep- 
ticus, one showing elevated, the other within upper limit of normal. Two cases of 
tabes dorsalis showed levels within upper normal limits (Table 5). 

SUMM.\RY .\ND CONCLUSIONS 

Elevated CSF GOT appears to indicate only acute central nervous system lesions; 
the blood-brain barrier eflfectively preventing serum transaminase, originating else- 
where, from entering the CSF. CSF GOT acti\'ity is thus more reliable than serum 
GOT levels for diagnosis of central ners'ous system lesions. Senmi GOT is elevated 
in some of the acute CXS lesions, undoubtedly caused by damage of the blood-brain 
barrier. The degree of elevation of CSF GOT has been correlated in proportion to 
the extent of infarction (4). 



26 BLLLETIX OF THE SCHOOL OF MEDICI XE. C. OF MD. 

Preliminary findings, although not conclusive, suggest a relationship between 
cerebrospinal fluid GOT levels and prognosis, i.e.: — high levels may be indicative 
of poor prognosis. The point is unproved and further data are needed. Whether GOT 
levels are helpful in diflferentiating brain tumor from other cerebral lesions is un- 
settled and needs additional study. 

The author is deeply indebted to Dr. Charles V'an Buskirk for his advice and to the members 
of the Departments of Anesthesiology- and Medicine and the Division of Xeurosurger>' for their 
cooperation. 

REFERENCES 

1. CoHEX, P. P. .\XD Hekuis, G. L.: Rate of transamination in normal tissues. J. Biol. Chem. 140: 

711-724, 1941. 

2. .\\v.vp.VRA, J. AXD Seale. B.: Distribution of transaminase in rat organs. J. Biol. Chem. 194: 

497-502, 1952. 

3. LaDue, J. S. -AND Wroblewski, F.: The significance of the serum glutamic oxalacetic trans- 

aminase activity following acute myocardial infarction. Circulation 11: 871-877, 1955. 

4. Wakqi, K. G. .AXD Fleisher, G. a.: The effect of experimental cerebral infarction on trans- 

aminase activity in serum, cerebrospinal fluid and infarcted tissue. Proc. Staff Meetings Ma_\-o 
Clinic 31: 391-399, 1956. 

5. K.ARMEX. A., Wroblewski, F. .an'd LaDce, J. S.: Transaminase activity in human blood. J. 

Clin. Invest. 34: 126-133, 1955. 




National Society 

for 

Crippled Children and Adults 

11 So. LaSalle Chicago 3 



THE UXI\ ERSITV OF MARYLAND SCHOOL OF MEDICINE 
AND COLLEGE OF PHYSICIANS AND SURGEONS 

1807-1957 
JOHN E. SAVAGE, M.D. 

Baltimore Town at the close of the Eighteenth Century and the beginning of the 
Nineteenth was experiencing rapid growth in population, commerce, and shipbuild- 
ing. There are various figures reported regarding the population in 1800 which var>' 
from 26,614 to 31,514. It is generally agreed, however, that there was an approxi- 
mate one hundred and twenty-five per cent increase in ten years. Baltimore was 
described as the geographic center of the Republic. With world trade controlled by 
Great Britain and the United States because of war on the Continent of Europe, 
Baltimore shared in the general prosperity. Tobacco, corn, wheat, and flour were 
the important staple exports. Shipbuilders produced the "Baltimore Clippers" which 
became world famous as the fastest commercial vessels afloat. In Februar}- 1799, the 
Baltimore-built frigate, "Constellation", had taken the French vessel, 'Tnsurgente". 

The city mourned the death of President Washington (December 14, 1799) during 
whose last illness, Dr. Gustave Brown, of Port Tobacco, was called as one of the 
consultants. In 1800 the United States government took formal possession of the 
"District of Columbia", and Congress met there for the first time in November of 
that year. 

City ordinances and State Legislature-approved measures permitted lotteries which 
were held to raise money for churches, schools, colleges, and all manner of civic im- 
provements, including the Washington Monument of Baltimore (corner-stone laid 
in 1815), the first to be erected to the memory- of George Washington. 

In 1796 (the year the city was incorporated). Dr. John B. Da\'idge, and in 1797, 
Dr. Nathaniel Potter settled to practice in Baltimore. The latter year was marked 
by an epidemic of what was then called "inflammatory bilious fever", but which 
was known to be j^ellow fever. Epidemics of this disorder became recurrent and re- 
sulted in considerable expense, invalidism, and death. The Legislature, in 1798, 
appropiated S8,0(X) for the erection of a Public Hospital, and an additional S3,0(X) 
was provided as the epidemic continued. The ^Medical and Chirurgical Faculty of 
the State of Mar>-land was incorporated in 1799. Dr. John Crawford, having received 
some "vaccine virus" from London, introduced vaccination in Baltimore in 1800. 
The Baltimore General Dispensary was organized in 1801, by Drs. John Crawford, 
James Smith, Robert H. Archer, et al. Vaccination against smallpox was endorsed 
by the Medical and Chirurgical Faculty in 1802, the first ofiicial recognition of 
Edward Jenner's great discover}' by any American society of physicians. 

Drs. Davidge and Potter frequently discussed the founding of a medical school. 
Dr. Davidge lectured on midwifery, surger\-, anatomy, and physiology at his resi- 
dence in 1802. Since he continued these lectures annually until the formation of the 
College of ]\Iedicine, they were considered to be its nucleus. In the same year, the 
Medical and Chirurgical Faculty appointed a committee consisting of Drs. George 

77 



28 BULLETIX OF THE SCHOOL OF MEDICIXE, U. OF MD. 




Fig. 1. John B. Davidge 

Brown, John B. Davidge, James Stuart, J. C. W'hite, and Edward Scott, to formu- 
late a plan and secure the necessary legislation for a medical college. 

The members of the faculty were confronted not only with committee duties but 
also with the examination of candidates for the practice of medicine and the en- 
forcement of the medical license laws, and the prevention and treatment of the 
general scourges extant at that time: yellow fever, smallpox, typhoid fever, and 
consumption. 

As a result of the efforts of the committee for the medical college, the legislature, 
on December 18, 1807, passed a bill creating "The College of jNIedicine of Mary- 
land". This act appointed as regents the Board of Examiners of the ]\Iedical and 
Chirurgical Faculty, together with the president and professors of the college. Dr. 
John B. Davidge was named the first dean, and he, with Dr. James Cocke, were 
joint professors of anatomy, surgery and physiology. Dr. Thomas E. Bond was 
professor of materia medica, and Dr. William Donaldson, professor of the institutes 
of medicine. Dr. Bond soon resigned and Dr. Nathaniel Potter was appointed in 
his stead. The college was chartered by the state in 1808. 

Public sentiment was so prejudiced against human dissection that a mob com- 
pletely destroyed a small anatomic theatre which had been erected by Dr. Davidge. 
Therefore, in the first session of the college, practical anatomy had to be abandoned 
temporarily. Lectures were given at the homes of the professors and some clinical 
instruction was given at the Almshouse. Illness of various members of the faculty, 
resignations, and poor quarters were trials of the new college in its early years. Drs. 
Elisha DeButts and Samuel Baker were appointed to the chairs of chemistry and 
materia medica in 1809. In April 1810, the first public commencement was held and 
degrees conferred on five graduates. Additions to the faculty in 1812 were Dr. Wil- 
liam Gibson, professor of surgery, and Dr. Richard W. Hall, adjunct professor of 



SAVAGE— U. M. SCHOOL OF MEDICINE, 1807-1957 



29 




Fig. 2. John Crawford 



obstetrics, and, in the following year, professor of the diseases of women and chil- 
dren. 

The year 1812 w^as of significance not only internationally and nationally, but 
also locally, for it marked the actual founding, by an act of the State Legislature, 
of the University of Maryland with the College of INIedicine of Maryland as its 
Faculty of Physic, as w^ell as the beginning of the construction of the present cen- 
tral building of the modern medical school group. By an act of the legislature, the 
then popular method of raising funds for its construction was evoked — a lottery— 
the proceeds from which were not to exceed forty thousand dollars. It is the oldest 
structure in this country from which the degree of doctor of medicine has been granted 
annually since its erection. At that time the building, modeled after the Pantheon 
at Rome, was located near the western boundary of the city, and provided an im- 
posing view of the Patapsco River and the upper Chesapeake Bay, according to 
contemporary historians. During the session of 1813, the new building was partially 
occupied; and, in that year, for SvSOO.OO, the Faculty purchased from his widow the 
library of the late Dr. John Crawford, consisting of over 400 volumes, which formed 
the nucleus of the ]\Iedical Library of the University of Maryland. It was opened 
for the use of the students in the fall of 1815. Apparently, the library was not e.\- 
tensively used nor was it well supported or adequately housed, until the purchase 
by the university of the old church building at the southeast corner of Lombard 
and (ireene Streets in 1905. It was named Davidge Hall. 



30 



Bl LLETIX OF THE SCHOOL OF MEDICINE, U. OF MD. 




Fig. 3. Davidge Hall 



The war years hampered but did not stop the functioning of the school. The lot- 
tery failed to produce the expected revenue and the members of the faculty were 
pressed by their creditors, even to the point of threat of actual sale of the property 
by the sheriff. Such disaster was narrowly averted by the procurement of loans from 
several banks. These circumstances were only the beginning of repeated financial 
crises. Meanwhile, recurrent epidemics of smallpox and yellow fever demanded 
much of the professional time of many of the faculty members. Peace was declared 
in 1815. Other lotteries were authorized by the legislature for the medical school in 
1817, with the stipulation that the income should not be greater than Sl(K),n()().00 
a year. Again the lotteries were not as productive as had been hoped, and by 1821 
the state issued 30 year certificates of indebtedness, in the amount of 830,000, to 
satisfy the accumulated deficit. The faculty gave bond to pay the interest but had 
to default, and in 1837 and 1840, the legislature came to their relief. Thus the fi- 
nancing of the medical school changed from private hands to the State, which has 
partially supported it since. 

When completed, the original medical school building contained two amphi- 
theatre-type lecture halls known as "Chemical Hall" and "Anatomical Hall". In 
the latter, in 1824, the degree of L.L.I), was conferred upon the ]Marquis de Lafay- 
ette; and in 1825, Dr. Ephraim McDowell, the "father" of ovariotomy, received the 
honorary Doctor of Medicine degree. 



SAVAGE— U. M. SCHOOL OF MEDICINE, JS')7-1957 



31 



Practice Hall was erected in 1821 to house the collection of anatomic prepara- 
tions, which the faculty purchased for §8,000.00 from Dr. (Iranville S. Pattison 
who had been appointed professor of surgery in 1820. Thus was the "museum" of 
the University created, consisting of over a thousand normal and {)athological speci- 
mens. It continued to grow by accessions in 1823, 1832, 1841 and 1861. However, 
by 1890, according to C'ordell, it was in a "lamentable condition". 

Adequate clinical instruction for its students was provided by the School of Medi- 
cine in 1823 with the erection of its own hospital, then known as the Baltimore 
Infirmary. It is believed that here for the first time in this country, medical students 
benefited by intramural residency training. There were four subsequent additions 
to this building which became the University Hospital. 

Crises, other than financial, beset the medical school in its early years. Factions 
within the faculty, added to the financial straits, apparently brought the state to 
seize the University of Maryland in 1825. It discharged the Board of Regents and 
placed the school in the hands of a Board of Trustees. The Faculty of Physic, in 
1837, withdrew from the control of the Trustees and formed another school, and the 
Regents sued for the recovery of their rights under the original charter. The Trustees, 
following this action, appointed a new faculty, the members of which continued the 
courses. The matter was brought before the Court of Appeals of Maryland, which, 
in 1838, decided in favor of the Regents who resumed control of the university in 
1839. Other internal strife appeared in 1843, when the first member of the faculty 
to be impeached by his colleagues. Dr. Richard W. Hall, w-as accused of incompe- 
tency, and violation of regulations. He was acquitted by the Regents. 

The Baltimore College of Dental Surgery, the first in the world, was organized 
in 1839, was incorporated in 1840, and later became the School of Dentistry of the 
University of Maryland. In 1840 the Maryland College of Pharmacy was organized. 
It was incorporated in 1841, reorganized in 1856, and became the School of Pharmacy 
of the University of ^Maryland in 1904. 

The two decades, beginning in 1840, witnessed interesting events, such as the 




Fig. 4. liAi.riMORF, Infirmary, liS23 



32 BULLET IN OF THE SCHOOL OF MEDICINE, U. OF MD. 

completion, in 1844, of the telegraph between Baltimore and Washington and the 
tirst message ever sent over wire on May 24; and in 1848, the lirst annual meeting 
of the American JMedical Association was held in Baltimore upon the invitation of 
the Medical and Chirurgical Faculty. Among the speakers on that occasion was 
Oliver Wendell Holmes. Edgar Allan Poe died in 1849; and epidemics of cholera 
and typhus fever afflicted the city. Improvements in the medical school curriculum 
were taking place. In 1841 organized instruction in auscultation and percussion was 
given, and these aids to diagnosis were announced in the catalogue for 1845. In 
this year also, instruction in operative surgery was formalized. The teaching of 
pathology as an independent subject began in 1847. Dissection was made compulsory 
in 1848, and the medical school became the first or second in the country to take 
this step. In the same year, attendance of the students at two sessions of clinical 
instruction became mandatory. The next years saw recurrent epidemics of yellow 
fever, smallpox, scarlet fever and measles. An addition to the University Hospital 
was built in 1850; and in 1854 courses in experimental physiology and microscopy 
became integral parts of the curriculum. The Peabody Institute was founded in 
1857. The population had risen from about 100,000 in 1840, to about 212,000 in 
1860. 

The year 1860 saw the sentiment of the people of Baltimore divided between the 
North and the South. The period of the Civil War (1861-1865) was a trying one 
with increased problems for the medical school, many of whose students came from 
the South. Emphasis in the curriculum was placed on military surgery and hygiene 
during the war years. Southern students ceased to enroll in the school and their loss 
was keenly felt. jMembers of the faculty served in the armies with distinction. Tide- 
water Maryland had slavery, while in the mountainous regions of the western part 
of the state, it was non-existent. At the end of the war. Southern students returned 
to the school and the enrollment again became normal. According to some w-riters, 
the charter of Washington University School of Medicine of Baltimore, which ceased 
to operate in 1851, was revived in 1867 by physicians and surgeons of the Con- 
federate armies. This school merged with the College of Physicians and Surgeons 
in 1877. 

From the end of the Civil War to 1900, numerous medical schools came into being 
in Baltimore. This was part of a national trend. The College of Physicians and Sur- 
geons of Baltimore City was organized in 1872, and merged with the University of 
Maryland in 1915. The Baltimore Medical College was founded in 1881 and joined 
the University of Maryland in 1910. In 1882, the Woman's Medical College of 
Baltimore opened, but ceased to operate in 1910. Baltimore University School of 
Medicine began in 1884 and closed in 1907. The Southern Homeopathic INIedical 
College came into being in 1890 (in 1907 its name was changed to Atlantic ]\Iedical 
College) and went out of existence in 1910. The year 1893 marked the opening of 
the Johns Hopkins University School of ]\Iedicine. A twenty year life span (1893- 
1913) was the lot of the Maryland Medical College of Baltimore. It will be observed 
that today there are two surviving medical schools in Baltimore, the School of 
Medicine of the University of ]\Iaryland College of Physicians and Surgeons, and 
the Johns Hopkins University School of Medicine. It will also be apparent that the 



SAVAGE— U. M. SCHOOL OF MEDICINE, IS')7-1Q57 



33 



former began as the College of Medicine of Maryland, became the University of 
Maryland in 1812, and had engrafted upon it three other medical schools from 1877 
to 1913. 

The last quarter of the Nineteenth Cenlur}- was characterized by growth, organi- 
zation, and building. In 1874 the Greene Street wing of the University Hospital was 
completed. City Hospital (not the present Baltimore City Hospitals) in 1877 came 
under control of the College of Physicians and Surgeons. The Anatomy Law was 
enacted by the legislature in 1882, and provided legal means for the various medical 
schools to obtain unclaimed bodies for dissection. In a cooperative enterprise, the 
faculties of the University of Maryland, School of Medicine, and the College of 
Physicians and Surgeons, assumed joint control of the medical appointments at the 
Bayview Asylum (the present Baltimore City Hospitals) in 1884. At the University 
of Maryland, a separate Lying-in Hospital was established in 1887. During the year 
1889, the Nurses' Training School Building at the University of jNIaryland w-as 
erected; the Johns Hopkins Hospital was opened; and the Johns Hopkins Training 
School for Nurses was opened. 

In 1890 an important step toward the elevation of standards of medical education 
was taken by organized medicine. At Nashville, Tenn., during the American Medi- 
cal Association meeting, the Association of American Medical Colleges was organ- 
ized. At the suggestion of the Baltimore Medical Colleges, regulations providing for 
preliminary examination and a three year course of lectures to become obligatory 
upon the member colleges at the session of 1892-93, were adopted. In 1891, the 
three year course became compulsory at the School of Medicine, University of 




mm 



Fig. 5. llNrvERsixY Hospital. 1896-1934 



34 



BIIJ.KTIX OF THE SCHOOL Of- MEDICI XE, C. OF MD. 



.Mar\laii(l. A new laboratory huildinj^ al the university was oi)ene(l in 1893. A four 
year course of study in medicine at the university became compulsory in 18%. 'i'he 
I'niversity of Maryland Hospital was completed and occupied in 1897. The year 
1899 marked the centennial of the .Medical and ( liirur<z:ical l''aculty of the State of 
.Marvland. Addresses by the governor and prominent physicians from many parts 
of the country were given as part of the exercises. 

A significant event at the medical school took place in 19(),-?, when a chair of the 
history of medicine was founded, the tirst professorship of this much-neglected 
department in this country. Appropriately, Dr. Eugene F. Cordell, who had devoted 
Uis life to the university and to the promotion of higher standards of medical educa- 
tion, was appointed to this position. 

The Twentieth Century had hardly begun, when, on February 7, 1904, "The 
Cireat Fire of Haltimore" destroyed the heart of the business center of the city. 
It was considered the most disastrous conflagration of modern times. The fire was not 
declared under control until after it had spread continuously for thirty hours, during 
which time approximately 2,500 buildings and 75 business blocks (covering over 140 
acres of ground) were consumed. Apparently a fortunate shift of the wind set the 
western boundary of the fire at Lombard and Howard Streets, just three blocks 
irom the medical school and hospital buildings of the University of Maryland. 




Fig. 6. Centennial Celebr.'vtion. 1907 



SA]'AGE U. M. SCHOOL OF MEDICINE, 1H,17-1957 _ 35 

The centennial celebration of the University of Mar3'land was held ]\Iay 30th 
and 31st, and June 1st and 2nd, 1907, with elaborate and appropriate exercises 
commemorating the occasion. A memorial volume was published, and a combined 
commencement of the various schools was held. Many distinguished visitors repre- 
senting various academic tields and institutions attended the exercises. Dr. Cordell 
was instrumental in starting an endowment fund during the centennial. It is believed 
that the existence of this fund was responsible for other gifts such as that by Dr. 
Frank (". Kressler of funds which provided the research laboratory which bears his 
name. 

The University of Maryland Base Hospital Unit Number 42 shortly after its 
organization in March 1918, for service in World ^^'ar I, received orders to increase 
personnel and equipment to care for 1000 patients instead of the originally expected 
500. A total of 350 persons was considered necessary for caring for the larger number 
of patients. Included were 34 physicians, 4 dentists, 100 nurses, and 200 enlisted 
men. It is interesting to note in the papers of the time an api)eal was made for raising 
an emergency fund of 810,000. Such a fund was to be used for numerous incidentals 
and comforts during the voyage and until the return home of all the persons involved. 
It seems that the government then provided only the bare necessities for each of 
these so-called Red Cross Base Hospital Units. Many of the physicians in the unit 
were faculty members of the medical school. That this unit served with distinction 
is attested by the high commendation it received from the Surgeon-General M. W. 
Ireland, U.S.A. The press observed that the University of Maryland, through Base 
Hospital Unit 42, maintained its spendid tradition of service during the greatest of 
emergencies. Many of the physician-graduates of the university served with honor 
and many gave their lives in the service of the country during \A'orld War I. 

An act of the legislature in 1920 actually created the University of Maryland as 
it is known today. This act joined the Maryland Agricultural College, at College 
Park, with the schools of medicine, nursing, dentistry, pharmacy, and law. Provi- 
sion was made in this act for coeducation. By the act the Board of Trustees of Mary- 
land Agricultural College became the governing body of the university under the 
designation of the Board of Regents. 

Attempts were made to secure funds for a new hospital as early as 1923 and 1924. 
These were unsuccessful and seemed to engender antagonism in high places. A bill 
was introduced which would provide certain funds for the hospital if the Baltimore 
schools would withdraw from the university. This bill was defeated. It was not until 
1932 that the legislature ap]:)ropriated 81,120,000 for a new hospital building which 
was two stories less than originally planned. It opened in November 1934, but it 
was not until 1937 that the legislature granted the university 8140,000 out of the 
new state loan to add the two stories for which funds were not available in 1932-34. 
At the same time, and from the same loan, 850,000 was provided to erect an addi- 
tion to the nurses' home. In 1940 the eleventh lloor was completed; and in 1947 the 
twelfth tloor was added and has been used continuously as house-staff quarters. 

The first major addition to the medical school buildings for some years came in 
1939 with the erection, through the bequest of the late Dr. I'rank C. Bresslcr, of 
the Bressler Research Laboratory. A number of preclinical departments of the 



36 



BULLET IX OF TIIK SCHOOL OF MEDICINE, V. OF MD. 







, 'o'oU-;:;'© 

lA; _ rt _ 

^ O O aid, o 
3-g-g £3^ 



• - tc o 
.Sii E 
E 



p; s 



^ -o c ^ 

p O ■- c 

.h 5 .ii a; 

-g '^ -a -o jj 

a .£ ^ '-^.H 

? '= ^ =S 

^ ca — ^ 






O J CQ O 



SAVAGE— U. M. SCHOOL OF MEDICINE, 1807-1957 



37 




O 



38 



BILLRTIX OF THE SCHOOL OF MEDICINE, U. OF MD. 




SAVAGE— U. M. SCHOOL OF MEDICINE, 1802-1958 39 

school, together with their research activities, have occupied the major portion of 
the building. 

With the advent of World War II, the medical school and hospital were seriously 
depleted of physicians and nurses. The faculty was reduced by approximately twenty- 
five per cent, and the large majority of nurses graduating during the war years 
entered the armed forces. Two lOOO-bed general hospitals, the 42nd General Hos- 
pital and the 142nd General Hospital, were, for the most part, staffed by University 
of Maryland ]>hysicians and nurses. These units served with high distinction in the 
Southwest Pacific Area, in the Philippines, India, and Japan. At one time in 1943, 
of 360 students in the medical school, Mi were in the armed forces. Many medical 
alumni of the university served with distinction in the armed forces, and some lost 
their lives. Many individual and unit citations were received by university alumni. 

The period from 1946 through 1953 was one of readjustment following the war; 
and of reorganization following the retirement and resignation of a number of de- 
partment heads. The Psychiatric Institute and a junctional wing with the general 
hospital were added to the plant in 1952-53. The present bed capacity of the hos- 
pital is 692 and 70 bassinets. On July 1, 1954, Dr. William S. Stone, formerly com- 
mander of the Walter Reed Army Medical Center, became Director of ^Medical 
Education and Research. In July 1955, Dr. Stone became Dean of the School of 
Medicine. Approximately one-third of the major departments have had new pro- 
fessors appointed, and a new department of Preventive Medicine and Rehabilitation 
was created in 1954. Lack of space both in the medical school and hospital is one of 
the most pressing modern problems; for example, only about twenty per cent of the 
space in the Bressler Research Laboratory is actually being used for research, the 
'remainder is occupied by basic science departments. To aid in the solution of this 
major problem, a plan to enlarge the Baltimore campus to more than four times its 
present size is under discussion. The tirst steps in this program have already been 
taken. The medical library is housed in temporary quarters while old Davidge Hall 
is being razed. On this site a modern health sciences library is to be erected. A new 
nurses' home is in the process of construction. Among other additions being dis- 
cussed are an administration building and a new out-patient building to replace the 
present structure which is the historic edifice, the tirst unit of which, constructed in 
1823, was the Baltimore Infirmary and later the L^niversity Hospital. Thus it would 
seem that the future will see the gradual replacement of all the buildings in which 
so much of the history of the medical school was made, with the exception of the 
grand old central "Pantheon". 



DEPARTMENT 

OF 
OBSTETRICS & GYNECOLOGY 



UNIVERSITY OF MARYLAND 
SCHOOL OF MEDICINE 



Summary of Admissions 

and 

Perinatal Mortality 



July I, 1955 through June 30, 1956 



I. SUMMARY 



1. Number of patients discharged 

2. Number of patients delivered and dis- 
charged (twins 39 sets, triplets 2 sets) . 

A. Patients delivered of viable infants. 

B. Patients aborting 

3. Maternal Mortality 

A. Rate per 1000 live births 

4. Number of viable babies born 

A. Term 

B. Premature* 

C. Immaturef 

5. Number born alive 

A. Term 

B. Premature 

C. Immature 

6. Number stillborn 

A. Term 

B. Premature 

C. Immature 

7. Number of neonatal deaths 

A. Term 

B. Premature 

C. Immature 

8. Total perinatal mortality 

A. Rate per 1000 live births 

9. Rate deducting immature deliveries . . . 



White Ward 



351 
1 

0.00 

310 
42 

2 

303 
39 

1 

1 
3 
1 

4 
2 
1 

52.4 
46.9 



355 
352 


354 

343 

11 



18 



Colored 



1561 
10 

3.20 

1287 

261 

36 

1276 

245 
27 

11 

16 

9 

6 

22 
24 

56.8 
36.4 



1811 
1571 

5 
1584 

1548 

36 

52 



Private 



1159 

58 

0.43 

1081 
81 
12 

965 

76 

6 

16 

5 
6 



41.1 
30.9 



1316 
1217 

1 
1174 

1047 

27 

16 

43 



Total 



3071 
69 

1.68 

2678 

384 

50 

2544 

360 

34 

34 
24 
16 

13 
32 
30 

50.7 
35.6 



3482 
3140 

7 
3112 

2938 

74 

75 

149 



* A i)remature baby is one which weighs between 1001 grams and 2500 grams. 
t An immature baby is one which weighs between 401 grams and 1000 grams. 



II. TOTAL DELIVERIES BY NUMBER OF PRENATAL EXAMINATIONS 













Fetal Loss 


Number of Examinations 


Wliite Ward 


Negro 


Private 


Total 






No. 


Per Cent 





116 


200 


6 


322 


32 


9.9 


1-3 


32 


118 


24 


174 


22 


12.6 


4-7 


43 


246 


123 


412 


20 


4.9 


8 or more 


106 


859 


890 


1855 


44 


2.4 


Elsewhere 


22 


16 


9 


47 


2 


4.3 


Unknown 


35 


145 


122 


302 


29 


9.6 


Total 


354 


1584 


1174 


3112 


149 


4.78 



41 



42 



BULLET IX OF THE SCHOOL OF MEDICINE, U. OF MD. 



III. TOTAL DELIVERIES 


BY PRESENTATION 








White Ward 


\egro 


Private 


Total 


Fetal Loss 




No. 


Per Cent 


Vertex 

Breech 

Face 

Brow 

C()tni)ouii(l 


326 
24 

1 
2 



1 


1504 
67 
5 

3 
5 



1124 
40 

3 

1 



2954 
137 
6 
5 
3 
6 
1 


105 
42 
1 

1 




3.6 
30.7 
16.7 

0.0 
33.3 


Transverse . . 


0.0 


Unknown 


0.0 






Total 


354 


1584 


1174 


3112 


149 


4.78 


Twins and other mul- 
tiple births 


6 


46 


28 


80 


5 


6.3 



IV. TOTAL OPERATIONS FOR DELIVERY 
A. Forceps and Cesarean Section and other Operations 



Low forceps, elective 

Low forceps, indicated 

Mid forceps, elective 

Mid forcejis, indicated 

Total forceps 

Cesarean section 

Breech, spontaneous 

Breech, extraction 

Breech, decomposition 

Breech, forceps to aftercoming head 

Total Breech 

Craniotomy and other destructive operations 

Version and extraction (single) 

Version and extraction (multiple) 

Spontaneous 

* 1 set twins. 

t 1 set twins. 



White 

Ward, 

No. 



161 

13 

4 





178 



Negro, 
No. 



640 

67 

27 





734 



Private, 
No. 



826 

43 

28 

1 



898 



Total 



No. 



1627 

123 

59 

1 



1810 



% Del. 



52.2 
3.9 
1.9 



58.0 



Fetal Loss 



No. 



27 



% 



0.5 

4.9 

10.2 

0.0 



1.5 



16 



81^ 



33 1 



130 



4.2 



14 



10.8 



2 
15 


13 



11 

43 



23 



4 
36 

1 
22 



17 
94 

1 

58 



51.8 



17 



54 



41 



112 



3.5 



32 



76.6 

20.2 

0.0 

6.9 



28.5 





1 



142 





1 

1 

712 





3 

1 

197 





5 

2 

1051 



33.1 



0.0 
0.0 
0.0 

7.2 



DEFT OF OBSTETRICS AND GYNECOLOGY— ANNUAL REPORT 
B. Episiotomy 



43 





White Ward 


Negro 


Private 


Total 


Median 

3° laceration 

Per cent 

4° laceration 

Per cent 

Mediolateral 

3° laceration 

Per cent 

4° laceration 


212 
5 
2.4 

10 
4.7 

9 

0.0 


0.0 


887 
47 
5.3 

20 
2.3 

29 

0.0 


0.0 


961 

10 
1.0 

14 
1.5 

32 
1 
3.1 


0.0 


2060 
62 
3.0 

44 
2.1 

70 
1 
1.4 




Per cent 


0.0 






Total 


221 


916 


993 


2130 



C. Other Operations 



Hysterostomatomy 

External version 

Induction of labor by rupture of membranes 

Pitocin induction 

Induction of labor, other 

Pitocin stimulation 

Manual removal of placenta 

Repair of cervical laceration 

Repair of vaginal laceration 

Prolapse of cord 

Willet forceps 

Single transfusion 

Multiple transfusion 

Shoulder dvstocia 



White 

Ward, 

No. 



1 


2 
1 
1 

16 
7 
5 
4 


11 
9 
2 



Negro, 
No. 



1 

2 

3 

11 

8 

15 

31 

34 

50 

11 

2 

71 

45 

6 



Private, 
No. 





4 

12 

40 

10 

53 

37 

18 

21 

2 

1 

22 

10 

3 



Total 



No. 

2 

6 

15 

53 

19 

69 

84 

59 

76 

17 

3 

104 

64 

11 



% 
Del. 



0.2 
0.5 
1.7 
0.6 
2.2 
2.7 
1.9 
2.4 
0.6 

i.i 
2.1 
0.4 



Fetal Loss 



No. % 



0.0 

16.7 

13.3 

11.3 

0.0 

2.9 



41.2 
66.7 



45.5 



D. Total Number of Deliveries with Previous Cesarean Section 





White 
Ward, 
No. 


Negro, 
No. 


Private, 
No. 


Total 


Fetal Loss 




No. 


% Del. 


No. 


% 


Vaginal delivery 


4 
11 


17 
30 


3 
16 


24 

57 


29.6 
70.4 


1 
4 


4.2 


Repeat cesarean section 


7.0 






Total 


15 


47 


19 


81 


2.6 


5 


6.2 







44 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 



TOTAL NUMBER OF LIVE BIRTHS ACCORDING TO WEIGHT AND CONDITION 

AT DISCHARGE 





White Ward 


Negro 


Private 


Total 


Grams 


Total 
live 
births 


Died 


Deaths 


Total 
live 
births 


Died 

24 

15 

5 

2 

6 


% 
Deaths 


Total 
live 
births 


Died 


% 
Deaths 


Total 

live 

births 


Died 


% 
Deaths 


401-1000 

1001-1500 

1501-2000 

2000^2500 

2501 & over 


1 

6 

10 

24 

302 


1 
2 


4 


100.0 

0.0 
0.0 
1.3 


27 

36 

62 

151 

1272 


88.9 

41.7 

8.1 

1.3 

0.5 


6 

6 

18 

58 

1059 


5 
2 

5 
1 
3 


83.3 

27.8 
1.7 
0.3 


34 

48 

90 

233 

2633 


30 
19 
10 
3 
13 


88.2 

39.6 

11.1 

1.3 

0.5 


Total 


343 


7 


2.0 


1548 


52 


3.4 


1147 


16 


1.3 


3038 


75 2.5 



VI. TOTAL NUMBER OF STILLBIRTHS ACCORDING TO WEIGHT 





White Ward 


Negro 


Private 


Total 


Birth Weight, 
Grams 


Total 
births 


Still- 
births 


% still- 
births 


Total 
births 


', u 

9 

5 

7 

4 

11 


% 
Still- 
births 


Total 
births 




% 
Still- 
births 


Total 
births 


in 


% 

Still- 
births 


401-1000 

1001-1500 

1501-2000 

2001-2500 

2501 &over 


2 
6 

13 

25 

308 


1 

3 
1 
6 


50.0 
0.0 

23.1 
4.0 
1.9 


36 
41 
69 

155 
1283 


25.0 

12.2 

10.1 

2.6 

0.9 


12 

7 

21 

59 

1075 


6 

1 

3 

1 

16 


50.0 

14.3 

14.3 

1.7 

1.5 


50 

54 

103 

239 

2666 


16 
6 

13 
6 

33 


32.0 

11.1 

12.6 

2.5 

1.2 


Total 


354 


11 


3.1 


1584 


36 


2.3 


1174 


27 


2.3 


3112 


74 


2.4 



VII. TOTAL NUMBER OF STILLBIRTHS AND NEONATAL DEATHS ACCORDING 

TO WEIGHT 





White Ward 


Negro 


Private 


Total 






JH 






ji 






JS 






-G 








a 






cd 






m 






a 




Weight, Grams 




Ja-o 






■3 -a 






o3-o 






tJa-a 






Total 




% 


Total 




% 


Total 




% 


Total 




% 




births 




births 


.a a 


births 


.3 a 


births 








£ 8 






•^ V 






■^ S 






XI o 








^ fi 






^ a 






^ a 






" a 


































CO 






CO 






CO 






VI 




401-1000 


2 


2 


100.0 


36 


33 


91.7 


12 


11 


91.7 


50 


46 


92.0 


1001-1500 


6 


2 


33.3 


41 


20 


48.8 


7 


3 


42.9 


54 


25 


46.3 


1501-2000 


13 


3 


23.1 


69 


12 


17.4 


21 


8 


38.0 


103 


23 


22.3 


2001-2500 


25 


1 


4.0 


155 


6 


3.9 


59 


2 


3.4 


239 


9 


3.8 


2501 &over 


308 


10 


3.2 


1283 


17 


1.3 


1075 


19 


1.8 


2666 


46 


1.7 


Total 


354 


18 


5.0 


1584 


88 


5.6 


1174 


43 


3.7 


3112 


149 


4.7 



VIII. ETIOLOGY OF PERINATAL MORTALITY 



Hemorrhage, intracranial 

Precipitate labor 

Breech 

Anoxia 

Placenta — premature separation of 

Placenta previa 

Toxemia 

Cord — umbilical compression of . . . 

Complications — medical 

Shoulder dystocia 

Development — anomalies of 

Infections 

Immaturity 

.Vtelecta.sis 

F.rythroblastosis 

Undetermined 





Premature 








Full Term 


w.w. 


Negro 


Private 


W.W. 


Negro 


Private 





4 




3 




2 


4 


2 





3 


1 




1 




3 


1 





1 


2 




1 




1 


1 


5 


39 




8 




1 


9 


4 


2 


26 


6 









2 


2 





1 


1 




1 




1 





3 


8 


1 









6 


1 





4 















1 

















































2 









1 





1 





1 


















1 


12 




6 
















2 




3 




1 
















1 




1 





5 


2 


11 




3 




4 


4 


7 



Total 



9 

6 

38 
4 

19 
5 





15 



66 



4 
1 

19 
6 
7 

31 



IX. CAUSES OF PREMATURITY AND IMMATURITY 





White Ward 


Negro 


Private 


Total 


Fetal Loss 




No. 


Per Cent 


Toxemia 

Hemorrhage 

Premature rupture of 

membranes 

Multiple pregnancy 

Maternal diseases 

Cervical pathology 

Fetal abnormalities 

Fetal death in utero. . . . 
Undetermined 


4 

7 

8 
4 

1 
1 
1 

18 


36 
49 

75 

28 



3 

9 

11 

86 


7 
13 

18 
6 

1 
3 
5 

40 


47 
69 

101 

38 

1 

5 

13 

16 

144 


6 
38 

11 

12 



1 


16 
19 


12.8 
55.1 

10.9 
31.6 

0.0 
20.0 

0.0 

100.0 

13.2 


Total 


44 


297 


93 


434 


103 


23.7 



X. COMPLICATIONS 
A. Total Number of Deliveries with Toxemia 





White Ward 


Negro 


Private 


Total 


Fetal Loss 




No. 


% Del. 


No. 


% Del. 


No. 


% Del. 


No. 


% Del. 


No. 


% 


Acute toxemia. . . 
Pre-eclampsia. . 

Eclampsia 

Chronic hyper- 
tension 

With toxemia. . 
Without toxe- 
mia 


18 
18 


30 
6 

24 


5.1 
5.1 
0.0 

8.5 
1.7 

6.8 


142 
140 
2 

215 

37 

178 


9.0 
9.0 

13.6 
2.3 

11.3 


31 
31 


53 
12 

41 


2.6 
2.6 
0.0 

4.5 
0.9 

3.6 


191 
189 
2 

298 
55 

243 


6.1 
6.1 

9.6 

1.8 

7.8 


8 
8 


24 
9 

15 


4.2 
4.2 
0.0 

8.1 
16.4 

6.2 


Total 


48 


13.6 


357 


22.6 


84 


7.1 


489 


15.7 


32 


6.5 



45 



46 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 



B. Total Number of Deliveries — Rh Negative 





White Ward 


Negro 


Private 


Total 


Fetal Loss 




No. 


% Del. 


No. 


%Del. 


No. 


% Del. 


No. 


% Del. 


No. 


% 


Rh Neg., sensitized 

Rh Neg., not sensitized 

Other isoimmunization 


6 

51 



1.7 
14.4 


12 
102 

1 


0.8 
6.4 


27 

157 




2.3 
13.4 


45 
310 

1 


1.4 
10.0 


10 
6 



22.2 
1.9 
0.0 


Total 


57 


16.1 


115 


7.2 


184 


15.7 


356 


11.4 


16 


4.5 



C. Total Number of Deliveries with Medical Complications 



Heart disease 

No failure 

Failure 

Tuberculosis 

Pulmonar\', active . . 

Pulmonary, inactive 

Elsewhere 

Diabetes 

Sickle cell anemia 

Syphilis 



White 

Ward, 

No. 


Negro, 
No. 


Private, 
No. 


T 


No. 


8 


31 


12 


51 


5 


30 


11 


46 


3 


1 


1 


5 


2 


17 


13 


32 





2 


1 


3 


2 


10 


10 


22 





5 


2 


7 





8 


4 


12 





9 





9 


1 


41 


6 


48 



% Del. 



1.5 
0.1 



1.6 



1.0 



0.4 
0.3 
1.5 



Fetal Loss 



No. 



20.0 

0.0 

0.0 

14.3 



9.8 



3.1 



16.7 
0.0 
0.0 



D. Prolonged Labor 



Pitocin stimulation . . 
Spontaneous delivery 

Elective forceps 

Indicated forceps. . . . 
Cesarean section .... 
Breech 

Total 



White 
Ward 



Negro 



6 

5 
17 

9 
12 

1 



Private 



Total 



7 
7 

21 

10 

12 

2 



Fetal Loss 



No. 



Per Cent 



0.0 
0.0 

4.8 

10.0 

0.0 

0.0 



50 



59 



3.4 



DEFT OF OBSTETRICS AND GYNECOLOGY— ANNUAL REPORT 



47 



E. Total Number of Deliveries by Pelvis 



Type of Pelvis 



Normal 

Contracted inlet 

Midplane contraction . . . 

Outlet contraction 

Inlet and outlet 

Inlet and midplane 

Midplane and outlet 

Inlet, midplane and outlet 

Asymmetrical 

Unknown 

Total 



Cases 



W.W. 



270 

4 
8 
3 


2 
2 

65 



Negro 



1276 

45 

62 

20 

1 

25 

26 

7 

1 

121 



Private 



916 

14 

25 

73 

1 

64 







81 



By Roentgen-ray 



W.W. 



26 
2 
5 




1 







Negro 

95 

28 

37 

2 



16 

14 

3 

1 





Pri- 
vate 



54 
3 

5 

10 

7 



14 



Fetal Loss 
(Cases) 



No. 



112 
4 
3 



2 

1 
27 



% 



4.5 
6.4 
3.2 
0.0 
0.0 
0.0 
6.9 
0.0 
100.0 
10.1 



Fetal Loss 
(Roentgen-ray) 



No. 



% 



3.4 
6.1 
4.3 
0.0 
0.0 
0.0 
0.0 
0.0 
100.0 
0.0 



354 



1584 



1174 



34 



196 



93 



149 



4.8 



11 



2.5 



F. Total Number of Deliveries with Hemorrhage 






White 
Ward 


Negro 


Private 


Total 
No. % Del. 


Fetal Loss 




No. % 



Antepartum Hemorrhage 



Placenta previa . . . 
Abruptio [)lacenta. 
Marginal sinus. . . 
Ruptured uterus. . 
Other causes 



4 


9 


4 


17 


0.5 


4 


9 


51 


19 


79 


2.5 


34 


1 


6 


2 


9 


0.3 


1 








2 


2 


— 





12 


34 


13 


59 


1.9 


6 


26 


100 


40 


166 


5.3 


45 



23.5 
43.0 
11.1 
0.0 
10.2 



Total. 



27.1 



Postpartum Hemorrhage" 



Total j)osti)artum hemorrhage. 



13 


62 


30 


105 


3.4 


— 



Postpartum hemorrhage is defined as blood loss of 500 cc. or more. 

G. Total Number of Deliveries According to Puerperal Morbidity 



Puerperal Morbidity 


White Ward 


Negro 


Private 


Total 




No. 


% Del. 


No. 


% Del. 


No. 


% Del. 


No. 


% Del. 


One day fever 

Puerperal infection 

Other causes 


3 

14 
10 


0.8 
4.0 

2.8 


41 

80 

111 


2.6 
5.1 
7.0 


37 
16 

24 


3.2 
1.4 
2.0 


81 
110 
145 


2.6 
3.5 
4.7 






Total 


27 


7.6 


232 


14.7 


77 


6.6 336 


10.8 



4S 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 
XI. CESAREAN SECTIONS 



Type of Operation 


White Ward 


Negro 


Private 


Total 


Fetal Loss 




No. 


% 


Low cervical 


11 
1 

3 

1 





59 
4 

11 

5 
2 



25 
4 

1 

2 
1 



95 
9 

15 

8 
3 



8 
3 

3 






8.4 


Classical 

Classical with tubal steriliza- 
tion 

Low cervical with tubal sterili- 
zation 

Classical and hysterectomy 

Extraperitoneal 


33.3 

20.0 

0.0 
0.0 
0.0 






Total 


16 


81 


33 


130 


14 


10.8 



Indications for Cesarean Section 



1. Pelvic contractions and mechanical 
dystocia 

A. Contracted pelvis 

B. Uterine inertia 

C. Malpresentation 

D. Large fetus — normal pelvis 

E. Failed forceps 

2. Previous cesarean section 

3. Hemorrhagic complications 

A. Abruptio placentae 

B. Placenta previa 

C. Ruptured uterus 

4. Toxemia 

5. Diabetes 

6. Miscellaneous 

A. Elderly primigravida 

B. Prolapse of cord 

C. Bad obstetric history 

D. Other 



White 
Ward 



Negro 



38 
8 
2 

3 



51 



10 
10 



Private 



11 



11 

5 



Total 



49 
10 

3 
1 
3 



5 

12 

1 



66 



27 
18 



Fetal Loss 



No. 



% 



6.1 
0.0 
0.0 
0.0 
0.0 



60.0 

25.0 
0.0 



0.0 

0.0 

0.0 

20.0 



4.5 



7.4 
38.9 



25.0 

0.0 

11.1 





XII. THERAPEUTIC ABORTIONS 




White Ward 


Negro 


Private 


Total 















DEP'T OF OBSTETRICS AND GYNECOLOGY— ANNUAL REPORT 



49 



XIIT. STERILIZATIONS 



Type of Operation 



A. Tubal, puerperium 

B. Tubal, not pregnant 

C. Accompanying cesarean sect. — tubal ligation. . . 

D. Accompanying therapeutic abortion — hysterot 
omy and tubal ligation 

E. Accompanying cesarean sect. — hysterectomy. . . 

F. Hysterectomy, not pregnant 

Total 



White Ward 



Negro 



5 



16 



2 



Private 



Total 



14 



24 




2 



23 



11 



40 



Indications for Sterilization 



Diabetes 

Previous section 

Hypertensive disease. 

Multiparity 

Heart disease 

Other 



White Ward Negro 





16 



5 

2 



Private 



Total 




24 

1 
11 



4 



Total . 



23 



11 



40 



XIV. MATERNAL DEATHS 



Total live births 

Total maternal deaths 

Total maternal death rate 

Registered births 

Maternal deaths in registered patients 

Maternal death rate in registered patients 

Non-registered births 

Maternal death in non-registered patients 

Maternal death rate in non-registered patients . 



2938 

6 
2.04 per 1000 live births 
2790 

4 
1.43 per 1000 births 
322 

2 
6.21 per 1000 births 



M. R., U. H., 019-5-11, a 21 year old colored female, para 1-0-0-1, was admitted 12/19/55 be- 
cause of pleuritic i)ain. She had had a D & C for incomplete abortion in September 1955. No regular 
menses since then but intermittent spotting. A roentgenograph of the chest showed a circumscribed 
lesion in the left upper chest, thought to be tuberculous in origin. The patient was treated medically 
until pleural biopsy revealed an hematothorax on 1/15/56. On 1/28/56, a gynecologic consultant 
suggested laparotomy for chorioepithelioma since bilateral ovarian masses could be detected. On 
1/31/56, a total hystereclom\', bilateral salpingo-oophorectomy was done. A microscopic examination 
did not reveal chorioepithelioma. On 2/12/56, the patient died suddenly in acute respiratory dis- 
tress. Autopsy: — Chorioepithelioma. left lung. 



Z. P., U. H., 024-2-73, a 23 year old registered, colored female, para 1-0-0-1, was admitted in 
early active labor 3/21/56 at 6:15 P. M. At 7:00 P. M. the membranes ruptured spontaneously. 
At 7:10 P. M. she was given 200 mgm. of Seconal orally and at 7:35 P. M., 50 mgm. of demerol 
and 0.2 mgm. of scopolamine intravenously. At the same time, full dilatation of the cervix was 



50 BILLETIX OF THE SCHOOL OF MEDICINE, L'. OF MD. 

oljtaincd. At 7:37 P. M., nilrous oxide and oxygen In- mask was started, the ratio l)eing 4:1. At 
7:41 P. M.. the patient was delivered of a full term living male child and the anesthetic agent was 
discontinued, and patient appeared to awaken soon thereafter. At 8:30 P. M. she could not be 
aroused. An examination revealed no pulse, blood pressure, or resjiirations. Attempts at revival were 
to no avail. .Vulopsy: — Aspiration of food particles in the l)r()nchi. Cause of death: — Anesthesia. 

H. \V., V. H., 067 7-75, a 40 year old registered, colored female, para 5-0-0-5, was admitted 
3/24/56, after an uneventful jirenatal course, in earlj- labor. After spontaneous rupture of the mem- 
branes, which contained large quantities of meconium, at 7:20 P. M. she progressed precipitously 
and delivered s])ontaneously a premature living female child. At 7:45 P. M., when the head was 
delivered, approximately 300 cc. of bright red blood escaped from the vagina. After delivery of the 
infant, another 700 cc. of blood followed. The uterus was immediately explored and a rupture found 
in the anterior lower uterine segment. Blood drawn during late labor for cross-matching, did not clot. 
Laparotomy: — rupture of the uterus, large hematoma in left broad ligament. She received 5 grams 
of filjrinogen 3500 cc. of blood, but bleeding was not controlled nor could a clot be made to form. 
The j)atient exi)ired 2 hours after delivery. Blood samjiles contained no detectable fibrinogen. Cause 
of death: — S])ontaneous rupture of the uterus; afibrinogenemia. 

L. v.. U. H., 080-7-30, a 38 >ear old white, registered female, para 1-0-3-0, admitted 9/29/55 in 
false labor, 3 weeks past term. The following evening she went into active labor and after 2 hrs. 
the fetal heart rate dropi)ed to 80/minute. The administration of oxygen was successful and at 12:40 
A. M. she was fully dilated. At 12:48 A. M. she was given saddle block anesthesia with 2.5 mgm. of 
nupercaine. Her blood pressure on admission was 130/80 and, after anesthesia, was between 120/80 
and 130/90. She was delivered of a full term stillborn child at 1 : 15 A. M. with the use of low forceps. 
The 3rd. stage was normal with a blood loss of 175 cc. Postpartum blood pressure was 120/80. At 
1:45 A. M. the patient appeared mildly cyanotic. Her blood pressure was 90/72, respirations were 
30 per minute. At this time, the patient complained of sharp epigastric pain. A medical consultant 
saw the patient at 2:00 A. M.; she was treated with oxygen, fluids and shock position. A general 
physical examination was essentially negative except for aspects of cardiovascular collapse. The 
lung fields at all times remained clear. At 2:20 A. M. her blood pressure was 100/70, pulse 120, 
respirations 36/minute. It was the impression of the medical consultant that the patient had a 
coronary occlusion. She died at 2:50 A. M. Cause of death: — Shock, undetermined, (possible coro- 
nary occlusion). No autopsy. 

L. H., U. H., 024-6-87, a 37 year old colored, registered female, para 4-0-2-4, was admitted 11/ 
10/55 because of projectile vomiting and disorientation in the 34th week of her pregnancy. After 
preliminary studies, a diagnosis of brain tumor was made and a craniotomy was performed on 11/ 
11/55 with excision of the tumor mass. The following day at 12:14 P. M., the patient expired. At 
12:18 P. M., a premature living male child w-as delivered, which survived. Autopsy: — Tuberculoma, 
basal ganglia, left and frontal lobe, left; leptomeningitis, tui)erculous. 

V. V\'., U. H., 068-0-07, a 36 year old, unregistered colored female, para 3-2-0-4, was admitted 
12/29/55 in active labor. She delivered the same day, after 7 hours of labor, a full term living female 
child without difJiculty. Her blood pressure was normal during her entire hospital stay. Immediate 
puerperium was normal, and she was discharged 1/1/56 in good condition. She was readmitted to 
the medical service 1/10/56, after having been found unconscious at home just prior to admission. 
Her blood pressure was 180/90 and, after physical examination and lumbar puncture, the diagnosis 
of subarachnoid hemorrhage was made. Later, revision of diagnosis was, hemorrhage into the left 
cortical and subcortical area with rupture into the subarachnoid space and jirobably into the cerebral 
hemisphere. She expired 1/12/56. Autops\-: — Thrombosis, superior sagittal sinus; intracerebral and 
suljarachnoid hemorrhage, secondary. 



OBSTETRIC CASE REPORT* 

C. H., a 25 year old, white, Para 1001, was admitted to the University Hospital 
at 3 :15 a.m. because of the onset of labor contractions. Her family and past history are 
noncontributory. Her first pregnancy terminated after a normal antenatal course 
with a delivery of a full term infant, a vertex, weighing 3246 grams. With this preg- 
nancy, the patient's antenatal course was uneventful with a weight gain of 18 lbs. 
Antenatal pelvimetry revealed a diagonal conjugate that was not reached at 123^ 
cms.; a slightly narrow pubic arch, an intertuberous diameter of 8 cms. and a pos- 
terior sagittal diameter of 8 cms. 

On admission the diagnosis of breech presentation was made with the presenting 
part floating. Fetal heart rate was 144 beats per minute on the left side of the ab- 
domen and the estimated size of the infant was 3600 grams. The cervix was 6 cms. 
dilated, 100 per cent effaced and the membranes were intact. The membranes were 
rather closely applied to the frank breech. 

Roentgen pelvimetry was obtained as soon as the diagnosis was made of a breech 
presentation. The following were the pertinent measurements: 

Obstetric conjugate — 11.4 cms. 

Transverse diameter of the inlet — 9.8 cms. 

Interspinous diameter — 8.8 cms. 

Anteroposterior of the outlet — 11.3 cms. 

This revealed a contracted anthropoid pelvis with rather marked transverse 
narrowing. On arrival back from the Department of Radiology, the patient was 
fully dilated with the presenting part still floating. An immediate cesarean section 
of the low cervical variety was done with a delivery of a full term living female child, 
weighing 4082 grams, at 4:48 a.m. on the day of admission. The patient had an 
uneventful postpartum course and the baby was discharged with the mother in 
good condition. 

DISCUSSION 

The patient's first pregnancy terminated without difficulty and, indeed, none was 
expected. No difficulty was expected at this time and it is suspected that if the breech 
presentation had not been present, the problem would not have been solved as 
quickly as it was. One hears the term, "tried pelvis", all too commonly. It is too 
generally believed that if a woman can deliver a baby one or more times successfully, 
she will be able to continue doing so ad infinitum in the future. This is a misconcep- 
tion. Disproportion can occur in subsequent pregnancies particularly when the 
infants are larger. 

The roentgen pelvimetry was not obtained because of the floating presenting part 
but because of the breech presentation. We have found it expedient to obtain roentgen 
visualization of the pelvis in all breech presentations regardless of parity. This policy 
proved to be sound. A marked transverse contraction was found which without 

* From the Department of Obstetrics and Gynecology, University- of Maryland Scliool of 
Medicine. 



52 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

doubt would have seriously handicajiped the delivery of a 4000 gram infant. It was 
felt that a live and uninjured infant could not be delivered through this pelvis vagi- 
nally. The use of the roentgen pelvimetry on all breeches is recommended unless it 
has been obtained in previous pregnancies. 

The patient also emphasizes that there has been a marked change in the general 
type of pelvic contraction among humans as is evidenced by the fact that at the turn 
of the last century, the common abnormality in pelvic contraction resulted from 
rickets producing a flat pelvis. In these patients, the diagonal conjugate usually 
could be reached with ease. Because of better diets, the rackitic pelvis has almost 
disappeared. In its place, the transversely contracted pelvis has become dominant in 
causing d3^stocia. In this type of pelvis the diagonal conjugate cannot usually be 
reached. IMost of them cannot be recognized by physical examination but only by the 
use of roentgen rays. In all patients in whom dystocia may be a problem, roentgen- 
ology is invaluable as an aid in diagnosis and therapy. 



SESQUICENTENNIAL YEAR 

1807-1957 




OF 

THE SCHOOL OF MEDICINE 

UNIVERSITY OF MARYLAND 

VOLUME 42 J^bj -^^^7 NUMBER 3 

EDITORIAL 

MAURICE C. PINCOFFS 

With the good wishes of his friends, the members of faculty and his former students, 
Maurice C. Pincoffs has retired as Professor of Medicine and Professor of Preventive 
Medicine. His success as a physician, teacher, preceptor and as a medical statesman 
has been great and has been recognized through the many honors he has received 
from the nation; from organized medicine; from his many students and from the 
University in which he chose to make his career. Although he remains active and 
strong of mind, his formal professional and academic career came to a close on May 
31st when a testimonial dinner was held in his honor. This was attended by many 
of the great men of medicine, former students, associates and those with whom he 
has served in the organization of the social aspects of medicine and in the planning 
of medical facilities for the nation and the State of Maryland. 

Aside from his prowess as a physician, Dr. Pincoffs offered his colleagues a deter- 
mination of thought, a penetrating attitude and an analytical sense which bespoke 
not only an active and integrative mind but a clear understanding of the many hidden 
facts of a complex problem. The crystallization of the essence of a complex order 
was his ultimate delight. Through this type of medical statesmanship he rose to 
great fame. The number of committees on which he sat, and often as Chairman, are 
perhai)s not known even to himself. His services to the school and to his community 
are indicated in the institutions which are a product of his influence and clear thought. 

As a j)hysician by the bedside he also ranks paramount among his associates. The 
meticulous thoroughness, the intense incjuiry into the more remote aspects of disease 
served him well. As an astute diagnostician and clinician his ecjual will be hard to find. 

A forceful teacher and an exemplary preceptor, investigator and medical editor, 
his professional life as directed to the practice of internal medicine has indeed been 
a rich one tilled with many lasting achievements. 

The inlluence of Maurice C. Pincoffs will remain in the School of Medicine. It has 
been too good, too healthy and too productive to die with the retirement of this one 
man. Although retired, he will remain as a consultant to the School of Medicine. 

53 



54 EDITORIAL 

His influence has already spread lo the younger men who are succeeding him in 
various capacities and who are proud to carry on the tradition he so carefully estab- 
lished during the many years of his tenure. 

In commenting on the early professional career of Dr. ]\Iaurice C. Pincofifs, Dr. 
Alan jNI. Chesney, one of the principal speakers at the Testimonial Dinner mentioned 
briefly some of the predictions of his early preceptors in Chicago, stating that he 
had a very line mind, a forceful personality and would make an excellent physician, 
recommending that the faculty of the Johns Hopkins School of JNIedicine accept him 
to advance standing. JNlaurice C. Pincofifs has repaid the confidence of his own pro- 
fessors in full. He thus climaxes a distinguished career with the knowledge that 
his life has been successful and that he has stepped down from his professional duties 
knowing full well that American medicine is better for his having been an active 
I)art of it. 

J. W. 



MEDICOLEGAL ASPECTS OF INFECTION 
RUSSELL S. FISHER, M.D.* 

The medical significance of infection as a complication of injury and as a primary 
process has concerned the physician since the earliest records of medicine. Now, 
during the last few decades, with the great growth of compensation legislation and 
medicolegal litigation, infection has assumed such forensic importance that it 
deserves special consideration because of its medicolegal aspects. The various 
ramifications are best considered in five categories: 

I. In industrial accident cases where infection complicates the accidental injury 
and leads to additional disability and hence cost. 

Little need be said here other than to stress the doctor's legal duty to exercise 
meticulous care in medical treatment with the use of antibiotics and surgical debride- 
ment where indicated. 

II. In occupational diseases where epidemiologic investigation following the 
establishment of a diagnosis is of medicolegal importance in establishing the compen- 
sability of the disease. 

Through the years an increasing number of infectious agents have been added 
to the list accepted as causing compensible disease. Anthrax, glanders, occupational 
tuleremia, brucellosis, psittacosis, leptospirosis and Rocky Mountain Spotted fever 
are well known among this group. The present law in Maryland no longer lists the 
diseases specifically but states "where an employee . . . suffers from an occupational 
disease ... or dies as the result of such disease and the disease was due to the nature 
of the occupation or process in which he was employed . . . the employee or . . . his 
dependents shall be entitled to compensation ... as if such disablement or death 
were an injury or accident." (1) This law obviously means that the Industrial 
Accident Commission will be guided by expert advice from the medical profession 
as to which diseases are caused by infectious agents and under what conditions 
they fall under the intent of this legislation. 

III. In accidental injuries not covered under the usual scope of the state and 
federal compensation laws where the question may be raised as to whether the 
plaintiff's own negligence was a contributory factor in causing the infection and 
hence the disability. 

In compensation cases, the statutes usually provide compensation "without 
regard to negligence" but in other accidents such is not the case and the proof 
that the plaintiff's own negligence contributed to his bad result may be a significant 
factor in the defense against a suit for damages. In general it can be stated that 
this situation is not regarded legally as "contributory negligence" but rather as 
"avoidable consequence". To (|Uote from one decision in this matter (2) "The rule 
of avoidable consequences is to be distinguished from contributory negligence in 
that contributory negligence is a bar to the action while the rule of avoidable conse- 
quences merely goes to the reduction of the damages caused by the defendant." \n 

* From the Division of Legal Medicine, Department of Medicine, University of Maryland, School 
of Medicine, Baltimore, Maryland. 

55 



56 BVLLETIX OF THE SCHOOL OF MFD/CINE, I'. OF SfD. 

example from Prosser (3) further clarities the situation "Thus, where the plaintifif 
is injured in an automobile collision, his contributory negligent driving before the 
collision will prevent any recovery at all but his failure to support proper medical 
care for his broken leg will bar only his damages for the subsequent aggravated 
condition of the leg." It will be up to the physician attending the case to supply 
the expert opinion as to whether the patient's complicating infection resulted from 
his negligence and further to aid the jury in evaluating how much of the final bad 
result was caused by the original injury and how much to the complicating infection 
as a result of the plaintiff's own negligence. 

I\'. In criminal cases, where an infection may be a signilicanl factor in the fatal 
result or in aggravation of the injuries inflicted by the defendant's assault. 

Here the degree of guilt of the assailant may be lessened if it can be demonstrated 
that the infection was intercurrent rather than a "natural consequence of the 
injury". Contrarywise, even though the deceased may have been negligent in his 
own care and thus contributed to the fatal result, the legal principle states — 

'Tf one unlawfully inflicts upon the person of another a wound calculated to 
endanger or destroy life, it would not be a defense to a charge of unlawful homicide, 
where death ensues, to show that the wounded person might have recovered if the 
wound had been more skillfully treated. Even unskillful or negligent treatment of 
the wound on the part of the wounded person or his physicians, which may have 
aggravated the wound and contributed to the death, does not relieve the assailant 
from liability. He must show that the negligent and unskillful treatment was the 
sole cause of death, before he can escape the consecjuence of his unlawful act on 
this ground. (4) 

V. In malpractice cases where the occurrence of infection either primarily or 
complicating injuries, may be the cause for tort action on a negligence basis against 
the medical practitioner. 

It is a principle of law that the mere failure of the physician to perform a certain 
act is not sufficient to justify an award in a malpractice suit. It must also be demon- 
strated that injury (infection) with harm to the patient resulted directly from such 
failure of the physician. 

Several of the more important variations in this field include: 

1. Failure to use known remedies commonly used hy physicians. It has been es- 
tablished that the treatment of dirty or penetrating wounds should include tetanus 
antitoxin administered prophylactically unless one can be sure that effective toxoid 
prophylaxis has been obtained when a toxoid ''booster" may be all that is indicated. 
Failure to render such treatment, if followed by tetanus, will establish a "prima 
facie" case of negligence which the court is apt to put to a jury for decision unless 
unusual extenuating circumstances are demonstrated. One such example is in the 
Pennsylvania case of Hodgson v. Bigelow (5), where the physician treated a wound 
of the thigh described as five inches deep but entirely subcutaneous without admin- 
istering tetanus antitoxin. The patient, an 8 year old boy, developed tetanus on 
the Sth day and, though he survived, rec|uired extensive and expensive hospitaliza- 
tion and treatment of his wound and the tetanus. At trial, the judge found in favor 
of the doctor in the negligence suit and did not allow the jury to bring in a verdict 



RUSSELL S. FISHER— MEDICOLEGAL ASPECTS OF INFECTION 57 

but the Appellate Court granted a new trial and the Superior Court affirmed this 
order. Pertinent excerpts revealing the thinking of the courts are "the facts on 
record amply support an inference that had the patient been treated with anti- 
tetanus serum when the defendant first attended him, the onset of lockjaw would 
have been averted." "No claim is made .... that failure to administer antitetanic 
serum was due to any hypersensitivity on the part of the patient." "The primary 
issue of fact was the nature of the wound. If it was a punctured wound (as its size, 
5 inches in depth with a diameter of ^2" indicates it was) all the professional wit- 
nesses on both sides testified in effect that the treatment administered by 
the defendant was not proper." 

One of the situations where an indication to withhold prophylactic antitoxin 
may occur is where there may be sensitivity of the patient to horse serum. It is 
in these types of cases that finest judgment must be exercised since it is now con- 
firmed medical opinion that the serum should be used in cases in which it is clearly 
indicated but it should not be given routinely, i.e., the bad resultfrom serum sickness 
or anaphylaxis might be held culpable if medical testimony indicated the risk of 
tetanus did not justify taking the risk of serum reaction. 

In this regard, too, Regan cites an interesting case where a mother whose 6 year 
old child suffered a penetrating wound of his foot, refused the administration of 
T.A.T. (6). The physician, not accepting the oral refusal as final, followed up with 
a letter by registered mail noting her refusal to allow the treatment and reiterating 
his recommendation. The child died of tetanus 10 days later and some months 
later, the physician received a letter from an attorney acting for the boy's parents 
threatening legal action against him "because of failure to care for the child in a 
manner consistent with the standard of practice in the community in that you did 
not give tetanus antitoxin to the child." When the physician produced the carbon 
copy of his letter to the mother with her signed "return receipt" the attor- 
ney dropped the matter with an apology to the physician. The moral to be drawn is 
obvious although frequently disregarded by busy practitioners today. The legal 
background of the lawyer's prompt withdrawal is of course based on a long 
established principle that the physician or dentist cannot be held liable for injuries 
consequent upon unskillful or negligent treatment if the patient's own negligence 
directly contributed to them to an extent which cannot be distinguished or 
separated. The converse of this holds true, however, and if the patient's contributory 
negligence and its bad effects can be separated from the physician's negligent harm, 
the plaintiff may recover "for such injury as he may show thus proceeded solely 
from the want of ordinary skill or care of the defendant (physician)." (7) 

In a suit against a dentist for osteomyelitis of the mandible, following a tooth 
extraction, where a fragment was left in, the facts developed that the dentist in- 
structed the patient to return on the day following the original extraction 
for "further examination and treatment." This she failed to do but presented herself 
four days later at which time infection had (level()i)ed to a serious degree. She was 
referred to an expert who extratled the broken root but, nonetheless, osteomyelitis 
requiring further surgery and leaving serious deformity followed. The testimony 
established that it was proper practice to postpone until the next day the root 



58 BILLETIX OF THE SCHOOL OF MEDICINE, C. OF MD. 

extraction because of {)regnancy and nervousness of the patient and that she failed 
to return the next day as directed. The Court stated (8) "If she had done so, for 
anything that appears, her trouble might have been completely alleviated and no 
further evil conse(|uences might have happened to her." "It is the duty of the pa- 
tient to cooperate with his professional adviser but if he will not, or under the 
pressure of pain cannot, his neglect is his own wrong or misfortune for which he 
has no right to hold his surgeon responsible. (McCandless v. Mc\\'ha 22 Pa. 261, 
268)". 

In the same way, there are legal decisions establishing negligence on the part of 
the physician where ophthalmia neonalorium developed and it could be shown that 
the physician failed to exercise prophylactic steps as provided for by law or by 
general practice in his community. These decisions mostly date back to the days 
when silver nitrate installation in the newborn's eyes was routine or required by 
law. Modern drugs have displaced argyrol but there seems no reason to doubt the 
precedent cases along this line would be applicable today if ophthalmia neonatorium 
is allowed to develop and prophylactic treatment has not been used. For example, 
in Walden v. Jones (9), the language of the court may be quoted — "Certainly the 
evidence that the defendant failed to place a prophylactic in the eyes of the new- 
born child is sufficient to conclusively establish negligence on the part of the physi- 
cian in the light of the uncontradicted medical testimony that in all localities phy- 
sicians ordinarily use silver nitrate or some other prophylactic in the eyes of a child 
at birth and that reasonable care and diligence require such to be done." 

2. Failure to exercise due skill and care in blood transfusion with the transmission 
of infection by the transfusion of blood from donors whose histories or whose blood 
or serologic study indicates they are not acceptable donors. Serum hepatitis is trans- 
mitted by blood transfusion and it may be assumed that the recipient who develops 
hepatitis will have cause for action against the physician(s) responsible for trans- 
fusing them with blood of donors whose history reveals hepatitis or even bona lide 
exposure to the disease within several months prior to the blood donation. (10) 
In the same way, malaria, measles and possibly syphilis may be transmitted via 
blood transfusion and it is incumbent on the blood bank operator to rule out active 
disease of this list in his donors by taking adequate history and serologic study. The 
genesis of septicemia or related conditions by the transfusion of bacterially con- 
taminated blood is a further variant of the same since it is commonly, though by 
no means correctly, (11) assumed that due care in operation of a blood bank will 
prevent such accidents. 

3. The causation of infection by the use of unstcrilc instruments. In Lanier v. Tram- 
mell (12), the basis for malpractice action was the loss of vision of an eye because 
of an infection wherein the patient alleged the eye specialist failed to sterilize instru- 
ments and to wash his hands before performing an operation. The surgeon lost, 
and an award of $5()()() was made. It is of interest that one of the defendant's argu- 
ments on apjjeal was that "even if it be conceded that appellant failed to sterilize 
his instruments and to wash his hands, this is not sufficient upon which to base a 
finding that such negligence was the proximate cause of the infection which caused 
the injury to the a[)pellee's eye." The court saitl "It is not recjuired in a case of this 



RUSSELL S. FISHER— MEDICOLEGAL ASPECTS OF INFECTION 59 

kind, that the injured party show to a mathematical certainty or to the exclusion 
of every hypothesis, that his injury occurred as a result of the negligence of which 
he complains" . . . and cjuoling Herzog . . . "but a showing of strong probability 
of the casual relation is sufficient . . . where negligence and injury are proved, the 
casual connection between them may be established by circumstantial evidence, by 
inference from physical facts." 

The same conclusions with an award of $8000, were reached in a suit against a 
dentist for infection following use of a non-sterile needle and no antiseptic at the 
site of injection in the case of Braham v. Veding (13) and against another physician 
who packed a post abortal uterus without exercising good surgical technique with 
subsecjuent fatal streptococcal septicemia. (14) In the latter case, the award was 
$4000. Several other more recent instances where infection followed poor surgical 
or nursing technique are recorded. 

4. Spread of disease by patients as when patients spread an infectious disease under 
circumstances where the physician failed to use reasonable skill or care to prevent 
such occurrence. This may arise because: 

a. The doctor does not recognize the disease as contagious and hence does not 
warn the patient. The Ohio Supreme court considered, in 1928, a case of black small- 
pox when the attending physician failed to recognize its dangerous nature and re- 
assured a neighbor, on direct questioning, that the disease was not contagious and 
presented no risk to the neighbor if he visited the sick. The neighbor attended the 
ill man until his death from smallpox and performed certain services with respect 
to preparation of the body for burial after death. The neighbor contracted smallpox 
and died. His widow sued the attending physician. The court specifically pointed 
out that it was the doctor's duty to know of the danger of contagion of smallpox 
and warn the neighbor of this fact and further that it was his duty to so acquaint 
himself with the signs and symptoms of the disease that he would not miss the diag- 
nosis. He failed in this latter duty and the verdict for the widow was affirmed. 

b. The doctor recognizes danger of contagion hut fails to inform the patient or his 
family of the danger, i.e. he fails in his duty to inform and the patient in ignorance 
spreads the disease by failing to exercise proper precautions. A child was taken to 
the hospital for treatment of a fever which soon became accompanied by a rash 
and was diagnosed as scarlet fever. The physician did not report the case to public 
health authorities nor did he advise the parents of the contagious nature of the 
disease. He allowed them to visit the child in the hospital and to take her home 
before the infectious period was past. Both parents contracted scarlet fever. They 
subsequently sued the physician and won. The court stated: "Generally speaking, 
one is responsible for the direct consequences of his negligent acts whenever he is 
placed in such a position with regard to another that it is obvious that, if he does 
not use due care in his own conduct, he will cause injury to that j^erson." (15). 

c. The doctor recognizes the disease as infectious or contagious but advises the 
patient incorrectly regarding its danger or the precautions to be taken. (16) A physi- 
cian was treating a patient for an infected wound. He advised the patient's wife to 
dress the wound and she in(|uired if there was danger to her. She was reassured that 
it would be safe to do as the doctor directed. She did and contracted an extensive 



60 BCLLET/X OF THE SCHOOL OF .\fF:DICL\E, U. OF SfD. 

skin infection herself. The court found the sequence of events to indicate neghgence 
on the doctor's part in that he improperly advised her she would be safe in dressing 
her husband's wound. 

SUMM.ARY 

The occurrence of infection in wounds of traumatic and surgical nature and the 
role of infectious agents in the spread of disease raise many medicolegal problems. 
A few of these, in the fields of criminal acts, civil litigation, including malpractice 
action, and compensible injuries and diseases, have been presented in an effort to 
bring the physician to the awareness of this medicolegal aspect of his everyday 
practice. 

REFERENCES 

1. .Vnnotated Code of Maryland, 1951 Edition; Article 101, Sec. 21. 

2. Sacony Vacuum Oil Co., Inc. v. Marvin, 21 NW (2d), 841 @ 847. 

3. Handbook Law of Torts, Prosser, Wm.; West Publishing Co. St. Paul, (1955) p. 287. 

4. State V. Karsunky; 84 Pac. (2d) 396. 

5. Hodgson v. Bigelow; 7 At. (2d) 338. 

6. Doctor and Patient and the Law; Regan, Louis J.; C. V. Mosby, St. Louis, 1956, p. 601, 

7. Hibbard v. Thompson, 109 Mass. 286. 

8. Gentile v. De Virgilis; 138 Atl., 540. 

9. Walden v. Jones; 158 S\V (2d) 609. 

10. The Physician and the Law; Long, Rowland, H.; Appleton-Century-Crofts, Inc. New York, 

1955, p. 153. 

11. Medicolegal aspects of blood transfusion; A,M,A. Committee on Medicolegal Problems, J..\ M..\. 

151, 1435. 

12. Lanier v. Trammel!; 180 S\V (2d) 818. 

13. Barham v. Weding; 291 Pac. 273, 277. 

14. Hafernan v. Seymer; 219 NVV 375. 

15. Skillings v. Allen; 173 NW 663. 

16. Edwards v. Lamb; 45 Atl. 480. 



A NOTE ON DETERiMINATION OF TRANSA^MINASE ACTIVITY 
IN BLOODY CEREBROSPINAL FLUID* 

MOTOJI MIYAZAKI, M.D. 

Determination of cerebrospinal fluid glutamic oxalacetic transaminase (GOT) 
has been found useful in indicating acute central nervous system damage. It has 
been reported that serum GOT activity is significantly elevated in hemolyzed serum 
as compared to non-hemolyzed serum (1). Therefore, it seemed desirable to determine 
the effect of an admixture of red blood cells (RBC's) on the transaminase activity of 
cerebrospinal fluid (CSF), since spinal fluid is frequently blood tinged or bloody. 
Also, xanthochromia often exists in CSF in which a knowledge of the transaminase 
activity may be clinically useful. 

Samples of CSF with normal levels of GOT activity were obtained and mixed with 
fresh blood in varying concentrations. Samples from four control patients were so 
mixed that concentrations of RBC's per cu. mm. of 87,000, 39,000, 27,000, 15,000, 
and 10,000 were obtained for each patient. These mixtures were incubated at body 
temperature and serial determinations of transaminase activity for each concentra- 
tion were made. Each specimen was centrifuged prior to the determination. The level 
of GOT activity was obtained spectrophotometrically by the method of Karmen 
et al. (2). 

Complete hemolysis was noted within 48 hours. In all specimens the transaminase 
activity was increased, reaching a peak in from 9 to 48 hours. Over the next 60 hours 
the GOT returned to near the original level. Those samples with the lower RBC con- 
centrations revealed a peak prior to complete hemolysis, while those with the greater 
number of RBC's showed the GOT peak at the time of complete hemolysis. In all 
the samples the GOT levels were within the normal range based on a control series. 

It is concluded, therefore, that whole blood in CSF will increase the GOT activity. 
This increase will be greatest at about the time of complete hemolysis when the 
greatest amount of the enzyme is released from the red cells. This occurs about 48 
hours after the bleeding and will have returned to insignificant levels by 100 hours 
after bleeding. The effect of blood pigment, oxyhemoglobin and bilirubin upon the 
spectrophotometer readings can be eliminated by the use of a normal sample of the 
CSF for comparison when making determinations on such fluid. In addition, the 
nature of the method used for this study, which is a measurement of the rate of a 
chemical reaction, would tend to reduce the significance of such a complicating 
factor. Cirossly bloody spinal fluid should be centrifuged promptly and the super- 
natant removed if more accurate transaminase levels are to be obtained. In the 
presence of subarachnoid bleeding the most accurate determinations will be made 
on CSF samples taken at least 4 days after the bleeding has occurred. 

REFERENCES 

1. LaDue, J. S., AND Wroblewski, F. : The Significance of the serum glutamic oxalacetic trans- 

aminase activity following acute myocardial infarction. Circulation: 6." 871 (June) 1955. 

2. Karmen, A., Wroblewski, F., and LaDve, J. S.: Transaminase aclivil\- in human l)l()o(l. J. 

Clin. Invest. 34: 126 133, 19.S5. 

* From the Division of Neurology, Department of Medicine, University of Mar\ land. 

61 



OUR DISTINGUISHED HONORARY ALUMNUS— EPHRAIISI McDOWELL 

JOHN C. KRANTZ, JR. 

The year 1807, in wliich the University of Maryland was founded, marked the 
birthdays of two great Americans, Henry Wadsworth Longfellow and Robert E. Lee. 
Two years later, on February 12, 1809, both Abraham Lincoln and Uharles Darwin 
saw the light of day for the first time. Later, Lincoln was to champion the cause of 
the bodies of mankind and Darwin was destined to sever the fetters of the mind. 




Ephraim McDowell 

It was in this year, on Christmas eve, that Jane Crawford looked into the courageous 
face of Ephraim McDowell and exclaimed, "I am ready, I have faith in your judg- 
ment and skill." These words have echoed down to us through the corridors of an 
ever-lengthening past — they are the epitome of the doctor-patient relationship. 

This valiant patient had traveled alone on horseback sixty miles over a mountain 
trail. She was seriously ill and burdened with a twenty-two and a half-pound ovarian 

62 



KRAXTZ—EPHR.AIM MCDOWELL 



63 



cyst. C. V. ]Mosby, in relating this ride by Jane Crawford, described it as fraught 
with more courage than the celebrated ride of Paul Revere, Sheridan's ride from 
Winchester, or the Charge of the Light Brigade in the Crimea. She had bade her 
family farewell, her path led through a virgin wilderness inhabited by unfriendly 
Indians. At the end of the trail she faced the uncertainty of a surgical procedure 
untried and considered beyond the pale of possible success. Dauntless she rode on 
prepared to die, prepared to live if ^McDowell succeeded. Without anesthesia, without 
the anti-infective drugs. Dr. McDowell's success as the pioneer ovariotomist is a 
matter of medical record. It was a milestone in abdominal surgery. Jane Crawford, 
who was forty-eight years old in 1809, lived to see her seventy-eighth birthday. 

Ephraim ^McDowell was born during the early rumblings of the American Revolu- 
tion on November 11, 1771, in Rockbridge County, Virginia. His ancestry was 




The house in Danville, Kentuck}-, where the first ovariotomy was performed b\- Ephraim McDowell 



Strongly Scotch-Irish. After the Revolutionary War, Samuel ^IcDowell, Ephraim's 
father, and his family migrated to the frontier town of Danville, Kentucky. It was 
in Danville, a village of about 150 inhabitants, that Ephraim spent his adolescent 
years. Young McDowell came under the influence of many distinguished friends of 
his father who stood high in the political life of the new community. He decided to 
study surgery. He was apprenticed to Dr. Alexander Humphreys of Staunton, Vir- 
ginia. Humphreys had studied in Edinburgh and after a few years of tutelage, young 
McDowell decided to follow^ the example of his teacher and study surgery in that 
venerable institution. Here ^McDowell came under the influence of the distinguished 
surgeon, John Bell. He made an indelible impression upon this student, which im- 
pression was to inaugurate a new era of surgery. Like William Beaumont, Ephraim 
^McDowell did not graduate from a college of medicine. He returned to Danville 



64 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

and at the age of thirty he enjoyed a wide medical and surgical practice. Besides, 
he had become a man of means and prominence in the community. 

The news of the successful ovarian operation could not be contained by the moun- 
tains of Kentucky. He sent the report of his operation to his old teacher, John Bell. 
He performed two additional ovariotomies. The contagion spread and other surgeons 
performed this operation. But in 1822 it was Ephraim McDowell who was called to 
Hermitage, Tennessee, to remove an ovarian tumor from I he wife of John Overton, 
the wealthy banker friend of Andrew Jackson. 

The fame of this courageous surgeon came to the attention of the faculty of the 
newly-established University of ^Maryland. In 1824 the faculty conferred the degree 
of Doctor of Laws upon the ]\Iarquis de LaFayette who was making a return visit to 
America. One year later the faculty conferred the degree of Doctor of Medicine upon 
Ephraim ^IcDowell. It was the only degree he ever received. The Rt. Rev. James 
Kemp, D.D., was Provost of the University, and John B. Davidge, ]\I.D., was Dean 
of the faculty. Elisha Debutts, who assisted Lyman Spalding in the compilation of 
the first United States Pharmacopeia, was Professor of Chemistry. 

It was fitting and proper for these early founders of our University to so honor 
Ephraim McDowell. While many other medical schools and associations in America 
and abroad were debating the wisdom of McDowell's courageous adventure in 
surgery, the faculty of this school had the vision to perceive its significance and 
accordingly honored this pioneer. 

Through the decades, as an unending procession of teachers of the ^Medical School 
have walked to the lectern in old Chemical Hall, and the old floor boards have re- 
sponded with their characteristic creaking sound, it has been an inspiration to recall 
that this is hallowed ground, for once here stood the father of abdominal surgery, a 
''backwoods Galahad," Ephraim McDowell. 



OBSTETRIC CASE REPORT* 

The patient was a 26 year old registered colored, STS negative, RH positive, 
para 6-0-0-6 who was admitted to the hospital on 10-26-56 in questionable early 
labor, with a history of passing about a cupful of dark red blood just prior to ad- 
mission. The past obstetric history revealed a spontaneous delivery of a live born 
10 lb 15 oz infant in 1*^)53 and a pregnancy in 1954 characterized by hypertensive 
cardiovascular disease and by a [)ostpartum hemorrhage due to uterine atony. The 
present prenatal course had these particular facets. 

1. JNIarked obesity and excessive weight gain. 

2. Borderline hypertension. 

3. Single footling breech presentation. 

4. Absence of fetal heart since 8-1-56. 

5. Estimated date of confinement was 9-30-56, so the patient was three weeks 
"past due date" on admission. 

When admitted, necrotic membrane was protruding from the vagina and one 
foot of the breech was presenting. Contractions which had started at 10:30 a.m. the 
morning of admission, were poor and cervical dilatation was slow but progressive. 
At 7:40 a.m., the cervi.x was 7-8 cm dilated, a foot was protruding from the vagina 
to mid-calf, intravenous lluids were being administered, bleeding and clotting time 
were normal. At this time a sterile tape was attached to the foot of the infant, run 
over a pulley at the end of the bed and a weight of one half pound was attached to 
its distal end. For the next twelve hours, there was no significant progress in cervical 
dilatation. Serial clotting times over this period were normal and the patient was 
given morphine sulphate, grains 1/4, at 3 a.m. At 9 a.m. the patient was put up 
sterile and examined. At this time, she was found to be fully dilated. 

MANAGEMENT OF DELIVERY 

Blood was brought to the delivery room to be held in readiness, general anesthesia 
with ether and cyclopropane was started and carried to the deep surgical level. Under 
the relaxation obtained, the second foot was delivered and the trunk was delivered 
to the level of the up])er abdomen using combined traction and "vis-a-tergo". Further 
progress was impossible at this point. Using scissors, the abdomen was incised and 
the abdominal contents removed. Following this, the diaphragm was incised and 
the thorax was eviscerated. Following evacuation of these body cavity contents, 
there was advance under traction to about mid-thorax of the infant. Once again 
there was impasse. At this point, the trunk was then severed from the thorax, and 
the upper portion was pushed upwards into the uterus, the arms were then brought 
down splinted alongside the thorax and using traction on the arms, the remaining 
thorax, shoulder girdle and head were delivered intact. The placenta was removed 
manually. The uterus was found to be intact on examination and no lacerations were 
present. An intrauterine culture was taken. The estimated maternal blood loss was 
250 cc. Oxytocics were given immediately following delivery of the placenta, and 

* From the case histories, Universil\- Hospital, Baltimore. 

65 



66 BVLLETIX OF THE SCHOOL OF MEDICIXE, V. OF MD. 

the postpartum course of this patient was essentially benign. She was discharged 
home on the seventh postpartum day. The aggregate weight of the component parts 
of the fetus weighed 5,188 grams or 11 lb. 7 oz. 

COMMENT 

This case is interesting from several points of view. First of all, the history of 
having a baby of excessive weight by previous pregnancy should have directed the 
attention of those who saw this patient in the prenatal clinic to the possibility that 
this individual was either prediabetic or a diabetic. Subsequent glucose tolerance 
tests after this last delivery indicate that this individual is most likely a diabetic. 
Restriction of weight gain would probably have been of marked benelit in this par- 
ticular case. The admitting doctor's attention to the possibility of clotting deficiency 
in this particular case was not too well founded. No cases of clotting deficiency have 
been recorded in intrauterine death of fetus up to 60 days. While it is realized that 
this patient had had no recorded fetal heart for 85 days, she was RH positive and by 
far the overwhelming majority of clotting deficiencies develop after retention of an 
infant, dead because of RH incompatibility. A single clotting time on admission 
was indicated but it is doubtful whether the serial clotting times during labor were 
necessary. During the 12 hours of relative inertia, it is felt that more effort should 
have been expended in getting this woman delivered. The use of a tape and traction 
on a known dead fetus is a recognized therapeutic procedure. By this manner one 
attempts to get closer apposition of the presenting part to the cervix and so stimulate 
stronger and more effective uterine contractions. When one half pound was not suf- 
ficient to produce this coaptation of the presenting part, increasing weights of one 
half pound could have been added up to a total of two to two and one half pounds and 
this would have probably expedited delivery of the infant. A point to notice particu- 
larly is the deep surgical anesthesia that was used for manipulation of this macerated 
fetus. It is essential that such manipulation be carried out under almost complete 
relaxation. The principle in delivery in such a case is reduction of fetal diameters so 
that delivery may be effected without injury to maternal parts. One should never risk 
laceration to the maternal uterus or maternal birth passage in an attempt to deliver an 
already dead fetus. Following delivery of the macerated portions of the fetus, an intra- 
uterine examination was mandatory in order to detect possible lacerations. Fortu- 
nately these did not occur. This patient must be given close follow-up in the clinic in 
order that attempts be made to prove her strongly suspected diabetes and a therapy 
may be instituted so that such an obstetric catastrophe will not recur. 



BOOK REVIEW 

An Atlas of Anatomy. ./. C. Builaiu (Inuil, J'ro/cssor <>J Aiuilnniy in llic I'Hivtrsily of Tornntn, 
4lh cdilion, Baltimore: Tlic Williaws & Wilkins Co. 634 plates. I<^50. J'rice SI5.()(). 
This atlas was well received in its first three editions and is now so widcl>' known tliat a detailed 
description here scarcely appears necessary. The illustrations of dissections depict a progressive 
display of the various regions and would be useful in the majority of dissecting room programs. Both 
line drawings and half tone illustrations are skillfully executed to delineate clearly important struc- 
tures and Iheir mutual relationships. The accomjianying text material makes no attempt at exhaus- 
tive description, hut consists of terse statements which emphasize the salient features and important 
interrelationships to l)o observed in each plate. The atlas will serve the student well and delight 
the surgeon more than ever througli the inclusion of numerous plates of great i)raclical value in 
connection with surgical procedures (ex.: in the neck, abdomen, thorax, jielvis, inguinal region). 
Many of the more common anatomic variations are shown and their fre(|uencies noted. 

In this new edition, (Irant's .\tlas has become even more comprehensive and useful. Author and 
publisher, by a skillful shifting and regrouping of numerous illustrations and the judicious deletion 
of a few others, have contrived to introduce more than 80 new illustrations without adding any 
perceptible bulk to the book. A decimal system of numbering the plates has been ada|)ted so that 
in future editions all plates may retain their present numl)ers regardless of the numl)er and location 
of new ])lates which may be added. Colors have been intensified in some illustrations and added in 
others. Hspecially noteworthy are the new plates of cross-sections of the neck, root of the neck, 
stellate ganglion, coronal sections of the orbital and nasal cavities, female perineum, dissections of 
the hilar of the lungs from various aspects, and a number of excellent photographs of the skull to 
illustrate the face, teeth, oral and nasal cavities and pani nasal strnitures. Doctor Grant is to be 
complimented upon this splendid new edition. 

\'ernon E. Kralil, Ph.D. 



67 



SESQUICENTENNIAL YEAR 
1807-1957 




OF 

THE SCHOOL OF MEDICINE 

UNIVERSITY OF MARYLAND 

VOLUME 42 OctobeVj 1957 NUMBER 5 

EDITORIAL 
TOWARD THE THIRD CENTURY 

On the 18lh day of December, 1807, the Legislature of the State of Maryland 
created a medical college in the City or precincts of Baltimore for the instruction of 
students in the various branches of medicine. 

In the Act it was explicitly stated that the college ". . . be established in the City 
or precincts of Baltimore upon the following fundamental principles, to whit; The 
said college shall be founded and maintained forever upon a most liberal plan, for the 
benefit of students of every country and every religious denomination, who shall be 
freely admitted to equal privileges and advantages of education, and to all the honors 
of the college, according to their merit, without recjuiring or enforcing any religious or 
civil test, or urging their attendance upon any particular plan of religious worship or 
service; nor shall any preference be given in the choice of a president, professor, lec- 
turer or other officer of the said college, on account of his particular religious pro- 
fession; but regard shall be solely paid his moral character and other necessary quali- 
fications to fill the place for which he shall be chosen." 

For a century and a half these principles have remained the basis for the continued 
development of the School of Medicine. The achievements of the past and the current 
academic role of the School of ^ledicine speaks well for the care and thought given 
the original charter and for the validity and usefulness of the principles displayed in 
the preamble of the founding act. 

On December 18, 1957, in commemoration of the passage of the Act creating the 
School of Medicine, the faculty, distinguished guests and educators will gather in 
Chemical Hall. A ceremony of re-dedication will be held to the high principles of re- 
ligious and educational freedom, scholarship and investigation which have been the 
enviable past of the School of Medicine. To this end the faculty will turn its attention 
in the years which lie ahead. 

This ceremony of re-dedication not only formalizes the end of the Sesquicentennial 
Year but opens a challenge to the younger men of the faculty, that they be reminded 
of the illustrious past which has been theirs to receive and in the half century which 
lies ahead that they give due attention to the responsibilities which they have as- 
sumed. May the Bicentennial of the School of Medicine in 2007 reflect the same warm 
satisfaction which the celebrants of the Sesquicentennial have enjoyed with respect 
to the contributions of their predecessors. 

69 



{SPECIAL ARTICLE) 

THE ROLE OE SURCIERY L\ THE MANAGEMENT OF CORONARY 
ARTERIAL LWSUFFKTENCY* 

DAVID C. SABISTON, JR.. M.D.j .\nu ALFRKD HLALOCK, M.D. 

The problem presented by patients with coronary arterial insutHiciency is one of 
the most difficult that is encountered in clinical medicine. The victims of this disorder 
who survive the acute attack fall into two broad groups: (1) those who have sustained 
one or more proved attacks of myocardial infarction with residual cardiac damage 
and who have an increased risk of subsequent coronary occlusion, and (2) those who 
suffer from intermittent or continual cardiac pain (angina pectoris) with or without 
proved myocardial infarction. Many of the patients in both groups may be treated 
by the use of coronary arterial vaso-dilators, anticoagulants, diet, hormones, and 
alterations in environmental stress. Despite these helpful adjuvants there remains a 
group of patients who continue to have pain that cannot be controlled by medication. 
Furthermore patients with previous myocardial infarction are in need of greater pro- 
tection against subsequent attacks. 

Coronary insufficiency is most often the result of coronary atherosclerosis. While 
the pathogenesis of atherosclerosis is incompletely understood it is recognized that 
it is a disease which may begin early in life and is characterized by a progression of 
the pathologic process. With development of lesions in the coronary arteries, obstruc- 
tion to coronary blood flow results. Acute coronary arterial obstruction is poorly 
tolerated primarily because of the fact that coronary arteries are largely "end arteries" 
and have few inter-coronary collateral communications. Such an acute occlusion may 
result in an ischemic area of myocardium which acts as a focus of conductive irrita- 
bility and immediate ventricular fibrillation may take place. When the occlusion de- 
velops more slowly, inter-coronary collateral channels have at least some opportunity 
to develop and to offer some protection. It is in this latter group of patients in whom 
chronic anginal pain is more likely to occur. In this situation collaterals are present to 
allow the myocardium to remain viable but any increased demand of the heart for 
oxygen cannot be met. Additional arterial flow to the cardiac muscle can be induced 
by (1) increased development of inter-coronary collateral vessels and (2) new growth 
of vessels into the myocardium from an extra-cardiac source. 

Extensive experimental studies by a large number of investigators have shown 
that protection against induced coronary arterial occlusion may be offered the heart 
of an animal. This protection results from any one of a number of surgical procedures 
on the heart and pericardium and in fact may result from pericardiotomy alone. Pres- 
ently available data suggest that the chief benefit derived from the various experi- 
mental operations is the result of an increase in the number of inter-coronary collat- 
eral vessels rather than the ingrowth of new vessels into the heart. 

* From the Department of Surgery, The Johns Hopkins University School of Medicine and Hos- 
pital, Baltimore, Maryland. 

t Investigator, Howard Hughes Medical Institute. 

70 



SABISTO.X A.\D BLALOCK— CORONARY ARTERIAL LXSLFF/CIEXCV 71 

The first surgical procedure for human coronary insufficiency was performed by 
Jonnesco of Bucharest in 1916 and consisted of a cervico-thoracic sympathectomy. 
Beck later reported the use of the pectoralis major muscle as a graft to the surface of 
the heart, and this was the beginning of a series of studies which he and his associates 
have continued. These contributions have added much to our understanding of myo- 
cardial revascularization. Numerous procedures have been advocated and include, 
cardiac denervation, epicardial abrasion, partial coronary sinus ligation, aortic- 
coronary sinus anastomosis, cardio-omentopexy, cardio-pneumopexy, implantation 
of an artery into the myocardium, and ligation of the internal mammary artery. The 
striking feature common to most of these technics is that each seems to result in 
benefit. Further, there does not appear to be any great difference in the degree of im- 
provement resulting from the various methods. This had led most of those interested 
in this field to employ one of the simplest procedures, such as the Beck I operation, 
in order to assure low mortality and morbidity rates. 

At the present time it seems advisable to recommend operation for those patients 
with angina pectoris whose discomfort cannot be satisfactorily managed with medi- 
cation. In this group the results are gratifying and the majority of patients experience 
definite improvement in their symptoms and exercise tolerance. Some are completely 
relieved of their discomfort and others are moderately improved. The choice of opera- 
tive procedure is a matter of individual opinion. Our present preference is for a simple 
procedure which is rapid and which is associated with little risk. It consists of a 
thoracotomy and dissection of a pedicle of mediastinal fat together with its vessels. 
A large area of the anterior pericardium is excised and theepicardium is destroyed by 
the application of concentrated phenol. Asbestos or talc is then applied to the surface 
of the ventricles and the mediastinal fat pedicle is sutured to the myocardium. This 
operation requires an hour or less and the mortality rate is low. 

It is apparent that the operations available are not the ultimate solution to the 
problem of coronary insutKiciency. Further studies in the experimental laboratory are 
needed. Technics for the direct removal of the occluding atheroma are being investi- 
gated. There is good reason to believe that progress in this direction will be made and 
that a more direct surgical attack will become feasible. 



DEOCIN: A NEW ANTIBACTERIAL ANTIPERSPIRAXT* 
RA^■.MOXD C. V. ROBINSON. M.D. and HARRY M. ROBINSON, JR., M.D. 

BALTIMORE, MARYLAND 

Shelley and Cahn (1), in 1955, demonslraled that neomycin, in a concentration of 
0.5 per cent, in lotion or ointment base, was effective in reducing the usual axillary 
bacterial flora which are frequently responsible for obnoxious body odors. Hexa- 
chlorophene and tertiary ammonium compounds, other antiseptics with low indices 
of adverse reactions, serve a similar purpose. Economic availability of these two 
chemical substances accounts for their widespread use. 

Deodorants may be classified into three general groups: Those which mechanically 
inhibit or impede the activity of the axillary apocrine sweat glands; those which have 
anti-bacterial or antiseptic cjualities; and those which mask odors. Some commercial 
preparations combine these properties. Any deodorant is potentially capable of pro- 
ducing allergic contact dermatitis. This eruption is popularly known as "deodorant 
dermatitis." 

Deodorants which act as antiperspirants usually contain an aluminum compound 
as the active ingredient. The most commonly used compound of this group is the 
aluminum chlorhydroxide complex. Although no statistics are available, it is the con- 
census of opinion of dermatologists polled by the authors that these aluminum com- 
pounds are responsible for the production of most cases of axillary "deodorant der- 
matitis." 

Deodorants which depend solely on odor-masking qualities are almost obsolete. An 
ideal deodorant-antiseptic should control bacterial fermentation products and should 
impede axillary perspiration without disturbing physiologic functions. This presents 
a problem which, in the light of our present knowledge, is insoluble. In view of this, 
the product should impede perspiration, control bacterial fermentation products and 
cause a minimum number of adverse reactions. It should be esthetically acceptable 
to the user and should be easy to apply. 

A preparation, Deocin®, containing 0.5 per cent neomycin sulfate, 20 per cent 
aluminum chlorhydroxide complex, 0.2 per cent methylparaben and 0.3 per cent 
n-butyl-p-hydroxybenzoate was submitted to the authors for study. It is the purpose 
of this paper to evaluate Deocin as a deodorant-antiperspirant mixture. 

THE STUDY 

Methods and Materials: The preparation is manufactured in simple lotion form 
which is applied with the finger tip or applicator from a plastic squeeze bottle, and in 
a "bomb" form dispenser which uses dichloro-difluoro-methane and dichloro- 
tetrafluoro-ethane as propellants. The lotion, which is in a greaseless base, is a faintly 
jierfumed white liquid. When applied sparingly to the skin it does not leave a residue. 
^\'hen the stopper of the pressure spray dispenser is depressed, the mixture emerges 

From the Division of Dermatology, Department of Medicine, Universit\' of Mar\lancl School of 
Medicine and University Hospital. 

* Deocin was sup[)lied b\- the Ujijohn Companw 

12 



ROBINSON AND ROBINSON— NEW ANTIBACTERIAL ANTIPERSITRANT 73 

TABLE I 

Effects of Repeated Applicalions of Deochi (Anlibaclerial AnIiperspiranI) on 262 Patients 





Frequency of 
Application 


Number of 
Patients 


Reactions 






Derma- 
titis 


Absces- 
ses 


Effectiveness 


Lotion in squeeze bottle 


Daily 
Twice weekly 


65 
22 


2 

1 


1 
None 


Effective 
Effective 


Lotion in pressure spray 
bottle 


Daily 

Every other (la\- 


87 
40 


2 
None 


None 
None 


Effective 
Effective 




Twice weekly 


38 


None 


None 


Effective 




Once weekly 


10 


None 


None 


Moderately effec- 
tive 



from the lip as a fine mist. If this is applied in one second bursts at a distance of eight 
to ten inches, no visible residue remains on the skin. 

Patient Selection: A total of 262 patients used this deodorant-antiperspirant 
preparation. Patients included in this study were drawn from the Medical School of 
the University of Maryland, the Nursing School of the University of Maryland, the 
out-patient departments of the University of ^Maryland and the Women's Hospital 
and the private practices of the authors. Eighty-seven patients used the lotion sup- 
plied in plastic squeeze bottles and 175 patients used the lotion supplied in pressure 
bottles. 

Method of Application: Patients were instructed to apply the lotion from the 
squeeze bottles with the finger tips or an applicator once daily to each a.xilla. 

Those patients who used the aerosol bottle dispensers were instructed to hold the 
tip 6 to 10 inches from the axillae and apply a single one or two second burst of the 
mist to each axilla. The patients included in this group applied the mist daily or at 
two, three, or seven-day intervals. Observations of this group of patients are sum- 
marized in Table L 

Summary of Observations: Five patients who used this preparation developed con- 
tact dermatitis in the axillae. Four of these had been previously afifected by other 
deodorants containing the aluminum chlorhydroxide complex. The fifth patient 
noticed an erythematous eruption after using Deocin daily for one month. Applica- 
tions were discontinued by this patient and the eruj)tion subsided after one week of 
local steroid therapy. 

One patient who had been under treatment for hydradenitis su])purativa (axillary 
abscesses) used the lotion but when new abscesses develo[)ed applications were dis- 
continued. 

All patients stated that the deodorant-antiperspirant preparation was as efTeclive 
as any commercial product previously used, and fifty-three people preferred it. 

On the basis of these observations, groups of patients were asked to apply Deocin 
at two-day intervals, twice weekly, or weekly. Seventy-eight patients who applied 
Deocin only two or three times weekly claimed that more frecjuent applications were 
unnecessary. When used once weekly, three of ten patients were satisfied with results. 



74 BILLETIX OF THE SCHOOL OF MEDICIXE, U. OF MD. 

DISCUSSION 

Of the six patients who suffered adverse reactions to repeated applications of 
Deocin, live had been previously irritated by other deodorants containing the 
aluminum chlorhydroxide complex. 

The patient with axillary abscesses was given Deocin, to use because of the 
neomycin content. When abscesses continued to develop, applications were dis- 
continued. 

The previous study by Shelley and ('ahn (1) obviated the necessity for cultural 
studies and control studies. 

SUMMARY .JlND CONXLUSIONS 

Deocin, a new antibacterial-antiperspirant, has been used by 262 patients. All 
users of this preparation stated that it was as effective as any deodorant-antiper- 
spirant previously used and lifty-three stated it was superior to any product previ- 
ously used. 

The addition of neomycin to the lotion adds antibacterial action to the antiper- 
spirant activity. 

Individuals who used both the squeeze bottle and "bomb" type applicator, pre- 
ferred the latter. 

It is the opinion of the authors, based on previous experience and statements of 
the patients in this study, that Deocin, an antibacterial-antiperspirant, is superior 
to most of the presently available deodorant preparations. 

This study indicates that Deocin is an effective deodorant-antiperspirant mixture 
with a low incidence of adverse reactions. 

BIBLIOGRAPHY 

1. Shelley, W. B. and Cahn, M. N.: Effect of Topically Applied Antibiotic Agents on Axillary 
Odor. J. A. M. A. 159: 1736-1738, Dec. 31, 1955. 



CATATONIC PATIENTS TREATED WITH INTRAVENTRICULAR 
CHOLINESTERASE* 

WILLIAM H. MOSBERG, JR., M.D.f and STEPHEN L. SHERWOOD, M.D.t 

In 1950 one of us (S. L. S.) attempted lo interrupt catatonic stupor by injecting 
certain synaptic depressant drugs into the cerebral ventricles of three patients. The 
drugs used were: freeze-dried human erythrocytes with Cholinesterase activity of Q 
Ach 250; Procaine; Pentamethonium Iodide and Fla.xedil. In the first case all four 
drugs were used; in the second case Cholinesterase, Pentamethonium Iodide and 
Flaxedil; and in the third case Pentamethonium Iodide and Fla.xedil were used. The 
Cholinesterase preparation proved the most active in one case -a young woman who 
had been in continuous catatonic stupor for six years except for eight weeks after a 
lobotomy ten months before injection, was aroused and remained in a considerably 
improved state for over three months after two injections. Of the other drugs, Penta- 
methonium (C5) was more efficacious than Flaxedil and Procaine; C5 was not as good 
nor as long lasting as the freeze-dried human erythrocytes in the first case. Procaine 
had the least effect; in doses sufficient to cause vomiting it produced no therapeutic 
results. For further details of the clinical course of these patients and for the theoretic 
considerations which led up to these studies the reader is referred to the original 
communication (3). 

Following the above clinical trial there ensued a period of laboratory research 
which demonstrated the feasibility of employing studies of carbohydrate metabolism 
and electroencephalography as well as clinical observation as means of evaluating the 
efficacy of such methods of treatment (5). Such laboratory methods of assaying the 
effect of intraventricular medication in catatonic patients were particularly desirable 
since clinical improvement — spontaneous or otherwise, transient or longer lasting — is 
not unheard of in this condition. In the present study we have attempted to conlirm 
the original clinical observations on a further series of patients and to study the effect 
of intraventricular Cholinesterase on the blood sugar tolerance to insulin and on the 
electrical activity of the brain. 

METHODS AND MATERI.AL 

Four long-standing, insulin-resistant, mute, waxy, incontinent catatonics were 
selected from the custodial wards of the Manteno State Hospital. Bilateral frontal 
burr holes were made and the wounds allowed to heal. Insulin tolerance tests and 
electroencephalograms were done on each patient prior to operation, following opera- 
tion but prior to intraventricular medication, and at intervals during the period of 
observation after treatment had begun. Insulin tolerance tests were done according to 

From The Manteno State Hospital, Manteno, Illinois, and The Department of Physiology, 
Illinois Neuropsychiatric Institute, Chicago. 

* Read at the meeting of the Society of Biological Psychiatry, Atlantic City, New Jersey, May, 
1952. 

t Present address: Dejiartment of Neurological Surgery, School of Medicine, Universitj' of 
Maryland, Baltimore, Maryland. 

J Present address: Severalls Hospital, Colchester, Essex, England. 

75 



76 BLIJJiTIX OF THE SCHOOL OF MEDICIXE. V. OF MD. 

the method of Braceland, ]\Ieduna and \'aithuHs (1). Electroencephalographic studies 
wore carried out on an eight channel (irass Electroencephalograph Model IIIB. We 
received from Dr. David Nachmansohn Acetyl Cholineslerase jjrepared by him in as 
pure a form as possible from the electric organ of the eel. The concentrated material 
was diluted in saline and injected with barbotage into the cerebral ventricles of three 
of these patients while the patient lay immobile without anesthetic or other disturb- 
ing medication. Immediately after each injection the patient's head was rotated in 
an attempt to facilitate distribution of the drug and he was placed in a sitting position. 
Of the three patients one received a total of four injections and the other two patients 
a single injection. The amounts injected varied between 1 c.c. and 2 c.c. of a 1:100 
dilution and between 0.1 c.c. and 0.2 c.c. of a 1 : 10 dilution. One patient had bilateral 
frontal burr holes only, received no intraventricular medication, and was saved for a 
control. All patients were observed in the same environment for seven months. In 
order to differentiate transient from longer-lasting effects, medications were given 
during the first month of observation and then no further medication for a period of 
eight months. 

RESULTS 

In two cases transient clinical improvement followed shaving of the head only. One 
patient showed transient clinical improvement following bilateral frontal burr holes 
only. 

In the other cases, within a few minutes of injection of Cholinesterase the grey 
cyanosis gave way to a pinkish tlush. The technician noted that it had become easier 
to draw blood from superficial veins. The patient began to look about, apparently 
attending to what went on in his vicinity. The cerea tlexibilitas was replaced by obedi- 
ence to commands. Spontaneous activity appeared and seemed fairly appropriate to 
their situations. Then they all spoke — usually within eight to ten minutes of the time 
of injection and the slowest within a couple of hours. This usually consisted of mono- 
syllables or short phrases, usually in answer to Cjuestions. Although in one of these 
three patients — he received only one injection of Cholinesterase — clinical improve- 
ment was observed only during the hour immediately following injection, the other 
two showed longer-lasting im[)rovement. In one of these latter patients, a severe feed- 
ing problem which had been present for several months prior to treatment was 
alleviated for five months. The other, who had been mute for at least five year prior 
to treatment, was able frequently to carry on a rational conversation six months after 
his last injection. The control case was not hel[)ed by the burr hole or the concomitant 
increase in attention on the part of the medical personnel. 

All four patients were exceedingly resistant to insulin before and after trephining. 
In each of the three patients who received Cholinesterase the resistance to insulin 
decreased and in the case receiving multiple injections it decreased progressively but 
in none of them did it ever become quite normal (ligs. 1, 2, 3). Before and after the 
burr holes were made the electroencephalogram of all four cases showed the presence 
of rather low voltage high frequency activity, as rapid as 25 to 50 per second. Follow- 
ing the administration of Cholinesterase there was a characteristic change in the 
electroencephalograms alpha activity began to interrupt or displace the low voltage 



MOSBERG AXD SHERWOOD—INTRAVENTRICU LAR CHOLIXESTERASE 77 



SEPTEMBER 6, 1951 




TIME IN MINUTES 

Fig. 1. Case 1, Insulin tolerance curves. The dates may be correlated with the case report 



"I ^ ^ 1 1^ 

10 20 30 40 50 60 70 

JECTION 

TIME IN MINUTES 



Fig. 2. Case 2, Insulin tolerance curves. The dates mav i)e correlated with the case report 




• 80- 



-1 1 \ 1 1 1 

10 20 30 40 50 60 70 

JECTION 

TIME IN MINUTES 



Fig. 3. Case 3, Insulin tolerance curves. The dates may l>e correlated with the case report 



7S Bril.F.TIS OF THE SC/IOOI. ()/■ \/F./)ICl\E, F. OF MD. 

fast aclivily. 'Plie loiitrol case sliowi'd no (han^c in his ckHirocMucplialo^raiii or in 
his tolerance to insuHn. A more detailed desiription of the elect roencephaloiiraphie 
lindings may l)e found in sul)sc(|uent publications ])v one of us (2, 4). Within a few- 
months of tlie time of injection in all cases the insulin tolerance tests showed some 
return of their resistance, and within seven months they had all drifted back to a 
state closely resembling that which they exhibited before injection of Cholinestcrasc. 
Each of the two patients who had received multiple injections of ("holinesterase 
and who showed more than transient clinical improvement, deteriorated abruptly 
when transferred to a larger ward with which they were previously unacciuainled.* 

Ki:i'()Kr OK CASKS 

Ciisc I. \\ . \\., wliiti' mak', 24 xcars of af;;o, was admilti'd to llu' Manlriio Slate H(isi>ilal on 
AuKusl 25, 1*)5(). His I'alhor, a lioavx' driiikor, died in l<>,^() and llio iialicnt lived in a four room tlal 
w illi his mother and sister. The i)atieiU did not walk or talk until lie was three or four years of a>;e. 
He entered ])arocIiial school at liie age of 6*2 ycurs, was very slow to learn in school, and hnished 
the eighth grade at the age of 16 years. He had ditViculty in obtaining em])loyment, was lired from 
several jobs, and then no longer sought emiiloymcnt. He had no social contacts after ka\ ing sihool 
and went to the cinema every day. Tn November 1<)40 he withdrew from everything no movies, 
no smoking, more (|uiet, refused food, did not go to lied until .^:()() or 4:00 .V.M. and staxfd in bed 
most of the da\', would sit on toilet seat for hours at a time, would not eat food unless it was i)re- 
I)ared for him, walked and talked slowly, did not shave, wash, or comb his hair. Shorth' before ad- 
mission to the hospital he began to show liostility toward his sister who was caring for him did 
not want her to toucli him, threw things at her when she came near him or awakened him in the 
morning. 

Between October l').S() and l)eceml)er \'-)>() he riHei\e(l forl\ four insulin shock trealmeiils; 
between Sej)tember iy5() and October 1950, ten electric slioek Inatnienls; iielween November 1''.S() 
and April 1951, thirty-six electric shock treatments; and lielwceii June t'^^l and .Vugust 1*)51, ten 
electric shock treatments. 

On examination in .\ugust 1951 he stood with head bowed forward and shoulders stooped. His 
arms lumg looseh' at his sides; there was no voluntar\' movement and no resjionse to commaiuls. 
'{"here was evidence of weiglil loss witii a long thin face, Schnautzkrampf, mouth hanging loosely 
oi)en, and occasional grimacing. He had lieen nuite for at least 14 months and there was no weejjing 
or laughing. There had been a great feeding i)roi)lem, having to be fed at all times; and in order to 
get him to swallow food wlien it was placed in his mouth he had been receiving several electro shock 
treatments every few weeks. .Vt no time had he fed himself. Waxy llexibilits was prondunnd; knee 
jerks and ankle jerks slightly hypoactive. ?Ie would not follow commands and would not follow 
objects with his eyes. 

On Septeml)er 4, 1951 bilateral frontal burr holes were made under local anesthesia. Prior to and 
following o|)eration he was mute and did not follow commands. On Se])tember 7, 1951 at 5:00 P.M. 
one c.c. of 1:100 electric eel Cholinesterase was injected into the riglit lateral ventricle. Close ob- 
servation of the j)atient was made for one and one half hours following injection but no change was 
a|)])arent. Then at S:30 P.M. he said "Hello" in answer to the greeting of an examiner, and although 
he did not engage in further con\ersation he did .sa\- "Ooodnight" in rejil)' to the examiner's bidding 
him goodlive. On the following da\-, although again mute, he would follow simjjle commands (e.g. 
"Raise >()ur right arm"), and he showed a sardonic smile with fluttering eyelids when an attempt 
was made to engage him in conversation. By September 11th (four days after injection) he seemed 
more reluctant to initiate movement in response to command and it was necessary for the examiner 



* Sherwood's t'a.se 1 (3), after showing considerable clinical imi)rovement for several weeks 
following intraventricular (MioIinestera.se, was found in catatonic stujior the morning following her 
going on a hosjjital j)icnic. This patient, as in our two cases, deteriorated afli-r suddenl\- l>eing placed 
in a large group of peojjle in an unfamiliar environment. 



MOSBERG AND SHERWOOD— INTRAVENTRICULAR CHOLIN ESTERASE 79 

lo nudge the limb in order to iiiiliate the motion; even then sometimes he paused during motion and 
another nudge was necessary to complete the maneuver. In response to questions, although he 
remained mute, the right side of his upper lij) trembled along with a stretching of the right corner 
of the mouth to the right and occasionall)' his lips parted slightly. 

On Sei)tember 11th at 11:50 A.M. one and one-half c.c. of 1:100 Cholinesterase was injected 
into the left lateral ventricle. Three minutes after injection blood pressure 115/70, the pupils were 
slightly larger, the left more than the right; and seven minutes after injection when asked whether 
he would like some food he answered "Yes" in a low-pitched, very slow, whis[)ering voice. Ten 
minutes after injection blood pressure 105/70. He then spontaneously flexed his neck, looked about, 
swallowed audibly, retched several times, anfl then again swallowed audibly a few times. He then 
lay supine and motionless except for smacking his lips together. Twenty minutes after injection he 
was projiped up in bed with luncheon tray resting on his lower abdomen and thighs. The nurse fed 
him his first mouthful and thereafter he ate unaided using a spoon and taking large portions of food. 
Upon 0[)ening his mouth he displayed a rather coarse tremor of lijjs with slight tugging to the right 
of corner of mouth; this decreased with repeated acts. He stared straight ahead most of the time, 
glanced down when spooning food, and again when mouthing it. After finishing a dish of creamed 
meat the patient was asked what he would like most and he jiointed slowly to a vegetable on the 
tray. In direct response to questioning he named coffee, milk, bread, and butter; but pears he called 
peaches, and was unable to name string beans. When asked "Which do you like better, milk or cof- 
fee?" he did not answer; but when asked "Do you want any more to eat" he answered "No". When 
instructed to drink the milk and cofYee he paused; then when told, "Take the milk first" he promptly, 
though slowly, reached with both hands for the cup with some tremor of fingers, and drank slowly 
in repeated sips usual!\' looking ahead, sometimes at the examiner. After drinking his milk he laid 
his hands down at his side and had to be prompted to drink coffee and then did so. When he fin- 
ished his coffee he was asked if he were finished and he answered "Yes". Then when asked if he 
wanted the head of his bed lowered he api)eared to consider for a while and then said, "I don't know". 
He had consumed the entire content of his tray by 1: 15 P.M. and five minutes later his blood pres- 
sure was 116/66. Toward the end of the meal again, upon request, he named each of the items on 
his tray (chicken, bread, butter, pears, milk, coffee) and when he came to the string beans which 
he had been unable to name before, he smiled and said, "String beans". He answered the greetings 
of other hospital personnel as they came in to observe him with "Hello", stated accurately "Yes" 
or "No" when asked whether he had seen them before or not, and exchanged "Goodbye" with 
them as they left. He followed simple verbal commanfls readily but slowly. He was left alone at 
about 1:30 P.M. and when visited again one-half hour later he no longer could be made to utter a 
sound, though he did continue to ot)ey commands readily, but slowly as before. He continued to 
feed himself and follow commands but remained untidy of bowel and bladder. On the morning of 
Sepleml)er 12th when asked, "Did you eat breakfast", he answered "Yes". If his upper limb were 
elevated and outstretched passively, he would retain that ])osturc until commanded to return the 
limb to resting position. 

On September 13, 1951 two c.c. 1:100 ('holinesterase was injected into the left lateral ventricle. 
Blood pressure immediately before injection was 110/68. One minute after injection there was faint 
flushing of cheeks. Four minutes after injection blood jjrcssure was 108/78 and patient began yawn- 
ing. Nine minutes after injection when the examiner had begun to again rotate the head the jiatient 
vomited non-projcctilely perhaps 75 c.c. semi-liquid ])artially digested substance. After vomiting 
he ai){)eared to become suddenly' aware of his surroundings. Blood j^ressure immediately prior to 
vomiting was again 108/68, and immediately after vomiting was 118/76. Ten minutes after vomit- 
ing his blood pressure was 96/60, and three minutes later it was 104/70. When asked whether he 
felt better he grunted apparently in the affirmative, but this was the only sound that he made fol- 
lowing this injection. He did seem more aware of persons about him and looked consistentl_\- in the 
direction of verbal stimuli. He readily carried out simple verbal commands. During the ensuing days 
he continued to follow commands readily but it was sometimes necessary to nudge him in order to 
initiate movement. On September 15th, two days after injection, one of the attendants, wondering 
whether one of the other patients had eaten, asked this patient; and he promptly replied, "I don't 
know". The patient's family visited him on the following da>', and, when the\' were unable to 



so Br I. LET] X or THE SCHOOL or mi-:dicixe. r. oi- \id. 

(.■nf;;if;i' him in any conversation, ihcy thought that there was little change in him since injection. 
\\ hereas he had al\va\s walked with a wide l)ase, heail bowed, and slow deliberate short stcjis. an 
attempt was made on September 13th to get him to hoUl his head and shoulders erect and walk with 
a more normal l)ase and stride. On each subsequent occasion this was accomplished only with re- 
peated encouragement and instruction. On one occasion at this time one of the nurses entered his 
room as he was looking out the window. Hearing her enter the room he turned around, looked at 
her, and smiled. This was the only occasion on which he was observed to smile spontaneously. When 
she started to take his blood jjressure he held out his arm without being told to do so. Throughout the 
period after this injection and ])revious injections he continued to soil his clothing and was observeti 
on fre(|uent occasions silting or standing barefoot in a puddle of urine. This was in spite of the fact 
that he had been instructed to use the bathroom on such occasions. On one such occasion, on Se]) 
tember 25th, the examiner pointed at the iniddle of urine on the floor and asked the patient what 
it was. He replied, "Water". On Sejitember 23rd and 24th he consistently answered simple questions 
in audible monosyllables (usually "yes" or "no"). 

On September 28th Cholinesterase was again injected intraventricularly — this time in a dilution 
of 1:10 as contrasted with the i)revious dilution of 1 : 1(K). .\t 10:15 .\.M. 0.15 c.c. Cholinesterase 
was injected into the left lateral ventricle. Blootl pressure at 10:13 .\.M. was 108/68; at 10:47, 
94 86; and at 10:55 .\.M.. 92 62. By 15 minutes after injection he was able to follow commands 
readily. Circumstances prevented any further observation immediately after injection, but later 
that evening he answered questions readily and accurately with a "yes" or "no", followed commands 
readily, and again \x\wn questioning described urine on the floor as "water". No further speech was 
elicited until October 10th, almost two weeks after injection; at which time when asked if another 
patient had eaten his breakfast, he replied, "I don't know". Likewise when asked whether he had 
awakened by himself or had been wakened by someone else, he responded in a low tone. "Woke uj) 
myself". Subsequent (luestions got no audible reply but occasionally an ap|)ropriate nod of the head. 
He continued to eat slowly l)ut feed himself all of his meals and ate rather well. Likewise he con- 
tinued to be untidy with i)articles of food and drink at)out his li])s. 

His appetite remained good and, whereas prior to the institution of this treatment he hafl to be 
given electric shock — three to four treatments every three weeks — in order that he would swallow 
the food after it was placed in his mouth, he was at that time feeding himself and consuming an 
adequate diet. He continued to follow commands well, show an interest in his surroundings, and 
answer questions occasionally with monosyllables until about the middle of November when his 
condition began to deteriorate. Whereas in recent weeks he had looked up immediately when some- 
one came into the room he now seemed much more slow to do so. He was slow to eat and on some 
occasions ate nothing at mealtime. He was lethargic and indifferent and seemed prone to spend 
most of the time lying in bed. He seemed more jmle than he had been, and even after being e.xjjosed 
to cold weather he remained pale. Blood pressure remained about the same; 1(X) 62 on November 
23rd. On November 26th, while being taken to the bathroom by one of the attendants, he suddenly 
colla])sed and fell to the floor. Apparently there was no loss of consciousness and no involuntary 
movement. Blood pressure immediately following this episode was 92/60. Several days later the 
[jatient's sister was very alarmed at his deterioration and asked, "He has appeared to be doing so 
very well. What has happened to him?" By the end of November the skin of his bony prominences 
had become reddened and siighli\- excoriated. He seemed constantly to lie in bed supine with tense 
flexion of the neck and a somewhat grimacing face, frowning as if experiencing repugnance or anxi- 
ety. When interrogated in a conversational tone the only detectable response was limited to l)rief 
soft grunts which seemed to be sounds of distress. Waxy flexibility was readil>' demonstralile. 

With the intention of again injecting Cholinesterase the head was shaved on November ,^()th. 
Upon visiting the patient about an hour after shaving of the head he was found to be much more 
aware of his surroundings and much more alert than previously. .Although no speech was elicitable 
he did follow commands readily. An independent observer, seeing the patient several hours later, 
felt certain that Cholinesterase had been injected. He continued to follow commands and eat fairly 
well until about the middle of January, 1952, at which time he appeared markedly emaciated and 
weak and spent most of his time lying suj)ine in bed. While sitting on a chair he allowed his head 
to rest at pronounced flexion of the neck, a jjosture which was soon resumed after the head was 



MOSHEKi, AM) SIH.KWOOI) I .\T K.W EM KK I LA l< ( IIOI.I \ ESI EKASI: SI 

passively placed erect. The eyelids were opened wide anfl ihe pupils were lar>;e. He received parcn 
leral feedings for several days and within a week again ajjpeared fairly well nourished. This situation 
[)revailefl without change until the middle of March at which lime he again rieteriorated spen<ling 
most of his time l>ing abed, supine and limp, with a facial expressifjn suggisling helplessness, he 
wilderment and despair. The pupils were of normal size and waxy (lexiMlily was present. The face 
was greasy in appearance and to touch and smell. He obeyed simple commands slowly; and move 
ments of the extremities were always accompanied hy moli<jns of his eyes an<l usually alsf* of 
the right side of his face. The eyes turne<l sharply ujjwarrl, if not also to right or left anrl the eye 
lids |>artly closed so that there was visible of each eye only a wide scleral crescent. There was also a 
rapid trembling about the eyes and a tense pulling of the right corner of the mouth upward and 
to the side, creating the appearance of a sardonic smile. Because of the feeding problem he was 
again placed on parenteral and lube feedings. 

Cii\i! 2. S. I'., white male, was born on .\ugusl 12, 1912. There were no complications at time of 
birth; early deveU^pmenl and childhood were uneventful. In his adolescence he was <les(rjbed as 
easy going and helpful about the house, and at one time he won a golf tournament among the cad 
dies at a l(Kal golf course. He completed high school and then worked as a foreman in a foundr)'. 
His father died in 1949; and his mother, wife, and tsvo daughters are living and well. 

He showed no evidence of nervous or menial disease until 1941 when he expressed fear that he 
might be arrested because of his association with Germans at his place of em|)loymcnl. One month 
later he became imjmlsive, antisocial, irritable, and atlem|>lerl suicifle by slashing his wrist. He was 
hospitalized in a private sanitarium where he received eight electric shock treatments, and then in 
another sanitarium where he received both electric shock anfl insulin. .Although he improved s<ime- 
what, he l*egan to show homicidal tendencies, es|)ecially toward his wife anrl children. In .N'ovember, 
1943, he was admitted to the Manleno Stale Hospital where he received ffiurleen electric shfK:k 
Ireatmenls an'l forty insulin sh'Kk treatments. ;\fler eleven months hf^spitalization he was allowed 
to return home, living with his |>arents and seeing his wife and children on weekends. He afljusted 
fairly well for the first two months but then gradually began to deteriorate and frerjuentiy went to 
his wife's home standing before the house and staring for hours at a lime. Although he was ol*e 
rlienl and difl everything he was tolrl to do, he did not utter a word after October, 1947. He would 
neither speak nor write replies to questions. In March, 1948, he was re-admitted to the Manteno 
State Hospital. At that lime he was mute, obeyefl orders in an automatic fashion, and was classified 
as schizo|)hrenia, catatonic ly(>e. 

C)n examination in .\ugust, 1951, h(; was mule but di<l appear to comprehenri 'jueslions and an 
swererl with merely a nod of his head. There were s|>oradic occasions when he would answer 'jues 
tions with a monosyllabic grunt. Particularly characteristic of his behavior was a pf>sture with 
shoulders bowed slightly forward, arms hanging loosely at his side, and answering of fjuestions with 
shrug of his shoulders. On September 4, 1951, bilateral frontal burr holes were made under local 
anesthesia. For three days following ojK'ration he showed marked im[)rovemenl — very talkative, 
res[>ondefl readily and rationally to questions, and fed himself, eating well. Hy the fourth day after 
oi)eration, however, he was again mule but ai>peared to unrlerstanfl questions and answer them with 
the ap|>ropriale nod of his head and shrug of his shoulders. It was fliscovered two weeks after opera 
lion that, although he would not answer a fjueslirjn, if one were to ask him the question and then 
instruct him to sa>' either "yes" or "no" he would rio sf>. In this manner he could also be made to 
si)ell his name. He remained untidy at all times. 

On Septeml>cr 21st, 1.2 c.c. of 1:KX) Cholincslerase was injected into the left lateral ventricle. 
BlofKl j)ressure immediately |)rior to injection was 114/76, anrl five minutes after injection was 
116/70. There was nrj immediate change in his behavior. Ap[)roximalely ten minutes after injection 
he was placed in a silting position and when asked how he felt, he no<lded his head in the affirma- 
tive. He was then instructed to say "Ves" and did sf>; then s|>elled his last name when instructed 
lo do so. The following conversation ensued: 

Q. Where is your home? 

.\. l>o yrni mean here or in f "hicago? 

f^. In Chicago. 

.\. I <lon't have any. 



82 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

Q. Do you have any sisters or brothers? 

A. Yes. (He bowed his head and did not amplify on the number, sex or names of his relatives; 
and, since it seemed to make him withdraw, the point was not pressed.) 

Q. What sort of work do you do? 

A. I don't do any work. 

Q. What is the name of this i)lace where you are now? 

A. Manteno State Hospital. 

Q. How long have you been here? 

A. I don't know, a long time. 

Q. What sort of work did you do before \ou came here? 

A. I did foundry work. 

Q. What sort of foundry work? Were you a moulder or a pourer? 

A. No, I just did foundry work. 

Q. Did you like it? 

A. It was all right, (shrugging his shoulders) 

Q. What would you like to do now? 

A. He nodded to indicate that he would like to lie down in bed. 

Q. Would you like to continue sitting up, get up and walk around, or would you rather lie down? 

A. He again nodded to indicate that he would like to lie down but could not be made to express 
this wish in words. 

Blood pressure fifteen minutes after injection was 115/84. It was not subsequently found pos- 
sible to get the patient to say anything other than a sporadic "yes" or "no" until three days after 
injection when he had had some visitors who had brought him some fruit and candy bars. Upon 
being questioned he stated that some visitors had brought it for him and named correctly each of 
the fruit and candy items. When asked what kind of candy bars they were and what Xhey were 
made of he answered "Dextrose". When asked how he knew this he said he had read it on the wrap- 
per. This fact was not mentioned on the wrapper of the candy bars which he had and when asked 
to point out the word Dextrose on the wrapper he looked at the wrappers for several minutes, ex- 
amined them thoroughly, and then said, "It is not there; I guess I must have read it somewhere." 
He again repeated the conversation outlined above concerning his home and occupation but again 
seemed to withdraw when mention was made of his family. 

He remained in about the same condition, occasionally answering questions with a "yes" or "no," 
eating well, and untidy, for about four weeks after injection; and then became very lethargic spend- 
ing the entire day lying in bed with the sheets pulled up over his head. When one attempted to lift 
him out of bed he merely sank back limply. When, however, he was placed in a standing position 
he maintained the standing posture, although he seemed to have his head more downcast than be- 
fore; the characteristic shrugging of his right shoulder and turning his head to the right remained 
the only answer to most inquiries. This lying in bed helplessly persisted for a period of five weeks. 
During this time, however, he continued to eat well, meticulously emptying each plate and then 
licking it with his lips, running the rim of the plate around his Hps and then literally scraping the 
plate with his fingernail and then licking it again. 

On November 28 he appeared to be improved sUghtly in that he was slightly more aware of his 
environment and seemed to take more interest in what was going on about him. On December 1 
his head was shaved preparatory to injecting Cholinesterase but upon entering the room to carry 
out injection he appeared more alert than usual and again he responded verbally to questions con- 
cerning his home and occupation. After asking him the same series of questions he suddenly said, 
"You just asked me all these questions several days ago, why are you asking me again?". x\lthough 
he did not again converse readily in this manner he continued to show alternating periods of lying 
in bed with the sheets over his head facing the wall with no response whatsoever to commands, and 
responding to questions with nods and shrugs and obeying simple commands rather abruptly. In 
March, 1952, he was transferred from the acute hospital to a larger ward. Whereas he had been for 
seven months in a room with four other patients he was now in a sixtj- bed dormitory. He abruptl)' 
withdrew, spending the entire daj' lying in bed with the sheets pulled up over his head and eating 
very little at mealtime. 



MOSBERG AND SHERWOOD— INTRAVENTRICULAR CHOLINESTERASE 83 

Three weeks later he was transferred back to the ward on which he had been hospitalized before 
the institution of treatment. There the attendant who had cared for him for three years before intra- 
ventricular medication had lieen given was very impressed with the change in the patient. Whereas 
previousl}' it had always been necessary- to escort the patient into the dining room at mealtime he 
now joined the queue and followed the other patients into the dining room, picked up his tray, 
carried it to the table, and consumed its contents. All of this was done spontaneous!)^ and without 
any instruction or persuasion on the part of the attendants. Even more impressive was the fact 
that the attendants had never heard him speak, and now he not only answered questions rationally 
but at times carried on a rational conversation. A specific example of the latter was his ordering 
cake and ice cream from the commissar\- when orders were being taken from the patients. 

Case 3. R. P., white male, was born on February 21, 1911 of Czechoslovakian parents. His parents 
are living and he is the youngest of six children. Three siblings died in infancy. All the children had 
a strict upbringing; and the patient was always bashful, no girl friends, no smoking, and only an 
occasional glass of beer. He was always shy and quiet, read a lot, and was clean and tidy. He com- 
pleted three and one-half years of high school, was considered a good student, and then attended 
night school two nights a week to study printing. In May, 1949, he became seclusive and had to be 
urged to eat and to care for himself; he complained of fatigue, became depressed, refused food, cried 
and laughed at intervals, and was very restless although he had always been a sound sleeper. He 
imagined someone was chasing him and trying to take him away, moaned a great deal as though in 
pain and complained of pounding in his head. Two years prior to the onset of mental symptoms his 
father had begun talking to himself, criticizing his neighbors, pacing up and down the tloor and 
hearing voices. When the patient was urged to go out he replied that his father always stayed at 
home and he wanted to stay home as well. He was admitted to the Manteno State Hospital on Au- 
gust 3. 1949, two and one-half months after the onset of his symptoms. He showed on initial examina- 
tion waxy flexibility, command automatism and was mute. In 1950 he had 34 metrazol treatments 
and in 1951 fifteen more, with little or no improvement. 

On examination in 1951 he was mute, untidy and frequently would maintain an anti-gravity 
posture for prolonged periods. His sitting and standing postures were characterized by his head 
being bent forward, eyelids drooping and upper limbs closely adducted. During repeated interviews 
and examinations he was completely mute except for grunting on one or two occasions. On Septem- 
ber 27th bilateral frontal burr holes were made. Approximately half of the operative procedure was 
carried out under local anesthesia, but then he became very restless and when sodium amytal was 
administered became more restless. Although a total of 20 grs. of sodium amytal was given intra- 
venously he was still restless at the termination of the procedure. 

He was observed for a period of three weeks after operation and then, since his behavior was 
unchanged, Cholinesterase was injected into the right lateral ventricle on October 15, 1951. Blood 
pressure immediately prior to injection was 134/86 and seven minutes after injection was 130/82. 
Chohnesterase, .2 c.c. of a 1 : 10 concentration, was injected into the right lateral ventricle. Although 
questioning was begun immediately following injection no response was obtained until eleven min- 
utes after injection at which time he began to show a form of echolalia. When asked his name, al- 
though he looked at the examiner and appeared to realize that he was being rjuestioned, he said 

nothing. Then when instructed "Say my name is R P ", he immediately answered 

"Say my name is R P ". Following this he repeated a number of other such phrases 

as "Say Harry Truman is President of the United States". An attempt was made under these cir- 
cumstances to test his digit span forward and backward. He was able to repeat six numbers forward 
but it was very difficult to explain to him the procedure of rejieating the numbers backward. He 
would first say the numl)ers as they had been given him and then repeat them liackwards. He was 
able to rci)eat three such numbers. He spoke in a clear intelligible voice, head and eyes still down- 
cast with no associated movement of any other part of the bod\- but speech was exj)losive and with- 
out hesitation. Following this he was asked where he was and when he did not answer he was in- 
structed to say "Manteno State Hospital" and did so. Following this a picture of a man was drawn 
and when it was shown to him and he was asked what it represented he said "Manteno". A picture 
of a house was then drawn but when asked what it was he gave no answer. By this time it was ap- 
proximately twent\'-five minutes after injection, and he seemed fatiguefl. .Mso during this time he 



84 BULLET I y OF THE SCHOOL OF MEDICISE, V. OF MD. 

would follow simple commands readily but not with the automatism which had typified him in the 
past. Since that time he has not been heard to utter a sound. Blood pressure at that time was 144/90. 

Although he remained mute, he continued to follow simple commands for ajjproximately three 
weeks after which time he reverted to his former state; no longer following commands, frequently 
maintaining an anti-gravity posture, and ap])earing to be totally unaware of the j)resence of the 
examiner. He usually fed himself but frequently it was necesary to place the first few mouthfuls 
in his mouth before he would do so. He has remained in this condition since early November of 1951. 
His face at all times has a pained expression. The automatic obedience of commands was noted on 
only one occasion — October 28, 1951, while movies were being taken. Transferring him to another 
ward in March, 1952, did not alter his behavior. 

Case 4. A. H., white male, was born on May 17, 1921. His father was born in Hungary and wasan 
excitable individual who had temper tantrums during which he beat his wife. The mother of the 
patient was born in Hungary, had five years of schooling, speaks four languages and is in good 
health. There are two sisters who are living and two sisters who are dead. He sustained a moderately 
severe head injury at the age of three. .\s a child he had many friends, liked to i)lay games; but had 
a bad temper, was obstinate and wanted his own way. He had frequent fights with his sisters, even 
as a youngster. 

At no time did he show any interest in girls. He completed two years of high school, but then began 
to fight with other boys at school after which he quit school. He never got along well with his father 
who beat him frequently, and he obeyed his mother much better than his father. In the summer of 
1936 he broke his glasses and, when he found it would take several hours to have them repaired, 
he threw knives and scissors at his mother and called her names. He became restless, angered easily, 
would not eat with the rest of the family, frequently locked his mother out of the house, had audi- 
tory hallucinations and paranoid ideas, and was resistive and untidy. He lost 50 lbs. weight in a 
short time. In November, 1936, he was hospitalized for one week in a Chicago sanitarium. Following 
this he refused to go to church, would not associate with an\' of his friends, would not bathe or change 
clothes, talked to himself constantly, and thought voices from Heaven were talking to him. Also he 
thought people were looking at him through the walls of the house, and thought neighbors were 
talking about him and frequently told them to mind their own business. In January, 1938, he was 
arrested for injuring his mother severely enough to necessitate her hospitalization. 

He was admitted to the Manteno State Hospital on March 5, 1938, at which time physical ex- 
amination was normal except for poor vision. Blood Wasserman and Kahn were negative and blood 
pressure was 110/70. In April, 1938, he completed a course of metrazol shock treatments and shortly 
after this made an attempt to escape from the hospital. In December 1938 he was described as fairly 
neat and tidy and well oriented as to time, place, and person. He spent most of the day idly sitting 
on the ward, quiet and cooperative. He gradually deteriorated and was described in 1941 as dull, 
indifferent, and in poor contact; in 1942 as deteriorating, destructive, mute and following commands; 
in 1945 as untidy, out of contact, and vegetative. 

On examination in August 1951 he was found to be mute, totally out of contact, and hallucinat- 
ing. His most characteristic posture was standing on one foot with his head turned to one side, upper 
limbs closely adducted to his body, head and shoulders downcast, and with his mouth almost always 
full of foreign bodies. Frequently he would suddenly look down at his hands or over into one corner 
of the room as though looking at some object which amused him. On these occasions he had a faint 
smile on his face and usualh' chuckled or laughed quieth' to himself. He did not follow any com- 
mands and indeed usually became combative when an attempt was made to get him to do some- 
thing. During these periods of resistance his facial expression became slightly defiant and angry and 
he pulled his arm away rapidly. His gait was always the same, taking a few running steps, very short 
and very effeminate, with upper limbs closely adducted to his body and head and shoulders slightly 
downcast. Then he would pause for a moment, frequently standing on one foot, and then run a few 
more steps and pause again in the same manner. This type of gait was also present when the exam- 
iner would take him b>- the arm and ph>sically encourage him to walk. .\t meal time when the tray 
was placed before him he did not seem to l)e aware of its presence but after two to three minutes 
he would begin to eat and consume the entire content of his tray. 

On September 27, 1951, under sodium pentothal anesthesia, bilateral frontal burr holes were 



MOSBERG AXD SHERWOOD INTRAVEXTRICCLAR CHOLIXESTER.ASE 85 

made. Despite the administration of a large amount of sodium pentolhal he remained restless through- 
out the j)rocedure. There was no change in his condition following operation and there was no change 
in his condition up to eight months after operation, the period of observation. Xo intraventricular 
medications were given. In April 1952 he was transferred back to the ward on which he had been 
hospitalized for two years prior to institution of treatment. The attendants on that ward stated that 
he seemed to follow commands a bit more readily than when they had last seen him, but that other 
wise they noticed no change in him. 

SUMMARY 

Bilateral frontal burr holes were made in four long-standing, insulin-resistant, mute 
waxy, incontinent catatonics. 

One of these patients was treated with multiple injections of intraventricular 
Cholinesterase; two with a single injection. All three patients showed immediate 
clinical improvement beginning within ten minutes after injection and most marked 
during the hour following injection. This improvement consisted of long-standing 
mutism being replaced by the ability to rationally answer questions (usually in 
monosyllables), disappearance of waxy flexibility and pallor, increased awareness of 
surroundings and ability to carry out simple commands. In one of these patients a 
severe feeding problem was relieved for five months; another frequently was able to 
carry on a rational conversation seven months after the last injection. In the third 
case the only clinical change noted was in the hour following injection. After this the 
patient reverted back to his former state and has so remained since that time. 

Following administration of Cholinesterase, the insulin tolerance test showed less 
resistance to insulin, and, in the electroencephalogram, abnormally fast low voltage 
activity was replaced by normal alpha. Several months after treatment the tests 
and tracings returned to their former state. 

In one case transient clinical improvement followed bilateral frontal burr holes only; 
in two cases transient clinical improvement followed shaving of the head. 

There was no change in one patient following burr holes only. 

ACKNOWLEDGMENTS 

The authors wish to express their gratitude to Dr. David Xachmansohn for providing the Cho- 
linesterase. Technical assistance in carrying out the blood sugar studies was rendered by the late 
Miss Ellen Ridley. 

REFERENCES 

1. Br.aceland, F. J., Medcxa. L. J., axd Vaichulis, J. \.: Delayed action of insulin in schizo- 

phrenia. Am. J. Psychiat.. 1945, 102: 108-110. 

2. Farrell, J. P. .AND Sherwood, S. L.: The alpha correlate to behavior changes produced in psy- 

chotics by intraventricular injections. EEG Clin. Xeuroph\siol., 1956, 8: 713. 

3. Sherwood, S. L.: Intraventricular medication in catatonic stupor (preliminary communication). 

Brain, 1952, 75: 68-75. 

4. Sherwood, S. L.: The response of jisychotic jjatients to intraventricular injections. Proc. R. 

Soc. Med., 1955, 48: 855-864. 

5. Sherwood, S. L., Ridley, E., and McCulloch, W. S.: Effects of intraventricular Acetylcholine, 

Cholinesterase, and related compounds in normal and "catatonic" cats. Xature, London, 
1952, 169: 157. 



THE CONTRIBUTION OF THE UNIVERSITY OF MARYLAND SCHOOL 
OF MEDICINE TO THE INITIAL DEVELOPMENT OF THE JOHNS 
HOI^KINS HOSPITAL AND THE JOHNS HOPKINS UNIVERSITY SCHOOL 
OF MEDICINE 

ALAX M. CHKSXKN', .\[.D.* 

DEAN EMERITUS OF THE MEDICAL FAdLTY OF THE JOItNS HOI'KIXS UNIVERSITY 

The contribution of The University of Maryland to the initial development of first 
The Johns Hopkins Hospital, and, later, of The Johns Hopkins University School of 
Medicine, is to be reckoned in terms of men and not in terms of money or buildings. 
That fact, however, does not lessen the value of the University's contribution in any 
respect. Rather it enhances that value for, as you well know, it is only man that can 
contribute ideas, knowledge and experience, and these are the most important in- 
gredients in the initiation and development of any human enterprise. 

Who were these graduates of the University of ^Maryland who by their knowledge 
and experience had a hand in the shaping of the two institutions which that shrewd 
old Quaker merchant and banker, Johns Hopkins, established in this city shortly 
after the end of the Civil War? Any attempt to answer that Cjuestion must of necessity 
begin with Mr. Hopkins himself. 

There is abundant evidence to show that Johns Hopkins knew intimately and con- 
sulted with two physicians who were graduates of the University of Maryland and 
practised here in Baltimore. He must have had great confidence in these two men for 
he made one of them. Dr. John Fonerden, a trustee of both his hospital and his uni- 
versity, and the other, Dr. Alan Penniman Smith, a trustee of his hospital. Both were 
born in Baltimore. 

Dr. Fonerden (1802-1869) received his M.D. degree from the University of JNIary- 
land in 1823 and from 1846 until his death in 1869 he was Medical Superintendent of 
the Maryland Hospital for the Insane. Johns Hopkins was a member of the Board of 
Managers of that institution, which stood on the site now occupied by The Johns 
Hopkins Hospital, and must therefore have seen a good deal of Dr. Fonerden while 
connected with that institution. It has been said that Fonerden was not only the 
personal friend but also the physician of Mr. Hopkins, and had great influence with 
him. He was secretary of the Medical and Chirurgical Faculty of Maryland from 
1828 to 1834, and was its first Librarian. He died four years before Mr. Hopkins and 
therefore played no part in the actual carrying out of Mr. Hopkins' plans. 



* (Dr. Chesney was the principal speaker at the Sesquicentennial Convocation, June 7, 1957 — Ed.) 

(Introduction) 
Dr. Stone, Distinguished Guests, Members of the Graduating Class, Ladies and Gentlemen: 

I count it a great honor and a high privilege to be permitted to share in these exercises which 
commemorate the one hundred and fiftieth anniversary of this veneral)le School of Medicine which, 
in spite of its advanced years, shows no signs of senility but, on the contrary, abundant signs of 
vigor and an aV>ility to grow stronger with each succeeding year. Permit me to offer my sincere con- 
gratulations on this happy birthday. 

86 



CHESNEV—U. OF MD. MEDICAL SCHOOL AND HOPKINS 87 

The other physician, Dr. Alan P. Smith (1840 1898), was the son and grandson of 
distinguished medical men. His father. Dr. Nathan R. Smith, was a Professor of 
Surgery in the University of Maryland and was known to the students and Faculty 
of the School as "The Emperor". The son received his JM.D. degree from the Univer- 
sity in 1861, taught anatomy and surgery there, and became a successful practitioner 
in the city. He was particularly successful with operations for stone in the urinary 
bladder. Like Fonerden, he was also a member of the Board of Managers of the Mary- 
land Hospital for the Insane, and, after Fonerden's death, became Mr. Hoj^kins' per- 
sonal physician. 

In addition to these two original physician-trustees, there was one other Univer- 
sity of Maryland graduate who became a trustee of The Johns Hopkins University 
and who may well have given Mr. Hopkins some advice, for both men belonged to 
the same religious sect, namely, the Society of Friends, and knew one another 
through that medium. This person was Dr. James Carey Thomas (1833-1897), a 
member of a well known Baltimore family, who was elected to his trusteeship in 
1870, while Mr. Hopkins was still alive. 

Dr. Thomas graduated from Haverford College, as so many of our good local 
Quakers have done, and then obtained his ]\I.D. degree from the University of Mary- 
land in 1854. A very devout man, he became a minister in the Society of Friends and 
devoted much time to philanthropic enterprises in Baltimore. He was greatly in- 
terested in higher education for women as well as for men, and one of his daughters, 
■Miss M. Carey Thomas, who became Dean and later President of Bryn Mawr Col- 
lege, had much to do with the raising of funds for the establishment of the Hopkins 
School of Medicine. His son, Henry M. Thomas, as we shall see later, also graduated 
from the University of Maryland and became associated with the Hopkins Hospital 
and the Hopkins School of Medicine in their earliest days. 

These, then, were the three University of Maryland graduates who were in a posi- 
tion to advise ]\Ir. Johns Hopkins himself in respect to hospital matters and to medi- 
cal education, and two of them, who continued to serve as trustees long after Mr. 
Hopkins' death, contributed significantly to the subsequent development of the 
Hospital and the University. 

Let us look now at the contribution made by graduates of the University of Mary- 
land to the Hopkins Hospital and the Hopkins School of Medicine at the professional 
level. Here the story is indeed a very striking one, but in order fully to understand it 
one must first understand several basic facts about the Hopkins institutions them- 
selves. 

The first of these facts is that The Johns Hopkins Hospital and The Johns Hopkins 
University are two entirely separate corporations, each with its own charter, its own 
funds, and its own board of trustees. The second fact is that the Hopkins School of 
Medicine is an integral part of the University and does not belong to the Hospital, 
although it necessarily enjoys the closest affiliation with that institution. The third 
fact is that the Hospital opened four and a half years before the School of Medicine. 

When, in 1889, after a building period of twelve years, the Hospital was finally 
ready to open its doors, there arose the necessity of organizing a [)rofessional staff 
for the institution. I-'or this purpose the authorities went beyond the borders of Balti- 



88 HCLij-.Tix or riiE SCHOOL or medicixe, r. or md. 

more and Maryland to select the heads of thcc linical departments. They already had 
an cxj^erienced pathologist in the person of Dr. William H. Welch, who had been ap- 
pointed Professor of Pathology in The Johns Hopkins University five years before, 
but they still had to have someone to head up each of the three main clinical depart- 
ments they were proposing to establish at the start, namely medicine, surgery, and 
gynecology. It was not proposed at that time to establish an active obstetrical service, 
but il was recognized, of course, that there would have to be a resident stafif. On the 
initiative and advice of Dr. Osier it was decided that this resident stafif should consist 
of a chief resident for each of the three clinical services who should be a man of consid- 
erable experience in the care of patients and should have one or more assistants, again 
wnth more experience than the recent graduate in medicine. Moreover, provision was 
made that these men might hold their positions for an appreciable period of time so 
that they might gain a greater experience and training than was obtainable in the other 
American hospitals of that day. Thus the American hospital residency system, as we 
understand that term, was born right here in Baltimore in 1889. 

Now each of the three men who came to the Hopkins Hospital in 1889 to head up 
a clinical department, namely Drs. Osier, Halsted and Kelly, brought as his chief 
resident, a graduate from a school outside the State of Maryland, but of the live indi- 
viduals who were appointed as assistant residents on the three clinical services which 
w-ere authorized at the opening of the Hospital, two were graduates of the University 
of Maryland. These were D. Meredith Reese and George E. Clarke, both members of 
:\Iaryland's Class of 1889. 

Two graduates of the University of Maryland also played an important part in the 
staffing of the Department of Pathology when the Hopkins Hospital opened and both 
of these gentlemen were destined to have distinguished careers. 

The first. Dr. William T. Councilman, was born at Pikesville in Baltimore County, 
and was the son of a physician who practised in that county. He graduated from the 
University of IMaryland in 1878 and at once entered The Johns Hopkins University 
as a graduate student in biology, working in the laboratory of Professor H. Newell 
Martin, the celebrated biologist. Here Councilman carried out an original investiga- 
tion on inflammation of the cornea which won him a prize of SIOO. He acquired an 
abiding interest in pathology and went abroad in 1880 to study the subject under von 
Recklinghausen at Strassburg and Cohnheim at Leipzig. Returning to Baltimore 
after three years he taught pathology in two local medical schools and performed 
autopsies at the Bay View Asylum. When Dr. Welch came to the Hopkins in 1884 
to be its first Professor of Pathology he found Councilman already working in that 
subject and at once recommended him for an appointment in the Johns Hopkins 
University as Associate in Pathology. In due time he became Resident Pathologist 
to the Johns Hopkins Hospital, the first to occupy that post, and as such he was Dr. 
W'elch's right hand man. 

Councilman was what would be called a "colorful" figure nowadays. Short, stocky, 
and of florid countenance, he stuttered slightly which gave an amusing twist to his 
profanity which was not minimal in amount! It is said that he used to transport his 
pathologic specimens from Bay View to the Hopkins in pails suspended from the 
handlebars of his bicycle. If true, that was no mean feat considering that Baltimore's 



CHESNEV—C. or MD. MEDICAL SCHOOL AXD HOPKINS 89 

streets were paved with cobblestones in those days. In 1892 he left Hopkins to become 
Shattuck Professor of Pathology at Harvard University and when the Peter Bent 
Brigham Hospital opened later on he was appointed its Pathologist. The University 
of ^Maryland can well be proud of the fact that he was one of its graduates. 

The other University of Maryland graduate who played an important role in the 
Hopkins Department of Pathology in the beginning was Alexander C. Abbott. 
Abbott was born in Baltimore (Feb. 26, 1860) and worked as a machinists' apprentice 
in the locomotive shops of the Baltimore and Ohio Railroad Company for four years 
before taking up the study of medicine. He graduated from the University of Mary- 
land in 1884, ranking second in his class, and then studied pathology under Dr. 
Welch as a regularly enrolled graduate student in The Johns Hopkins University in 
the year 1886-87. Dr. Welch suggested that he prepare for a career in public health 
and that he go abroad for study. This Abbott did, working in the laboratory of von 
Pettenkofer in INIunich and then in Robert Koch's laboratory in Berlin. Returning to 
Baltimore in 1889 he was given an appointment on the staff of the Hopkins Hospital 
in bacteriology and hygiene, and was given living quarters in the institution, so that 
he was in reality a member of the Hospital's first resident staff. 

In 1890 he left the Hopkins to become an assistant to Dr. John Shaw Billings, who 
had assumed the post of Director of the Laboratory of Hygiene of the University of 
Pennsylvania. In 1896 he succeeded Dr. Billings in that post and later became Chief 
of the Bureau of Health of Philadelphia. Abbott too, is a son of whom the University 
of Maryland may well be proud. 

Perhaps, at this point, it may be well to summarize the relation of University of 
Maryland graduates to the first resident staff of The Johns Hopkins Hospital by 
saying that of a total of ten individuals on that staff four, or forty per cent, had ob- 
tained their ^NI.D. degrees at that University. 

It is now time to turn our attention to the relation of University of ^Maryland gradu- 
ates to the Out -Pat lent Department of The Johns Hopkins Hospital. As we have al- 
ready seen, when that institution opened there was provision for only three major 
clinical departments, medicine, surgery and gynecology, but since other specialties 
in medicine had already been recognized by that time it was necessary to give them 
recognition if the patients of the hospital were to receive complete care. Accordingly 
those special fields were recognized by establishing divisions in the Out-Patient De- 
partment to take care of the patients whose illnesses fell within those sjjecial fields. 
It then became necessary, of course, to find competent doctors to head up those spe- 
cial divisions and it was here that graduates of the I'nivcrsity of Maryland proved to 
be particularly helpful. 

For the division embracing the diseases of the nervous system the authorities of 
the Hopkins Hospital turned to Dr. Henry M. Thomas (M.D. 1885), for diseases of 
the genito-urinary system to Dr. James M. Brown (M.D. 1867), for diseases of the 
eye and ear to Dr. Samuel Theobald (M.D. 1875) and to Dr. Robert L. Randolph 
(M.D. 1884), and for diseases of the skin to Dr. Robert B. Morison (M.D. 1874). 
Thus four of the five special divisions in the Out-Patient I)ei)artment of The Johns 
Hopkins Hospital when it opened in 1889 were headed up by (we University of Mary- 
land graduates and I should like to take a few moments to say a brief word about all 
of these men. 



90 Bii.i.i-.Tis or THE scf/ooL or MEDICI XE, r. or MD. 

Dr. riiomas (1861 1M2,S) was theonly son of Dr. James Carey Thomas, The Johns 
Hopkins I'niversity trustee who has been mentioned earher. He studied at Haverford 
College anfl then took special courses in The Johns Hopkins Cniversity. I-'ollowing 
his graduation from the Cniversity of Maryland in 1<S<S5 he studied pathology under 
Dr. Welch and pre])ared himself for his sj^ecialty, diseases of the nervous system, In' 
study at the Cniversity of Heidelberg. He was a successful i)ractiti()ner in Baltimore 
and his patients were devoted to him. 

Dr. James Brown (1854 1895) was a native of Baltimore and for a time Resident 
Physician at Bay \'iew. He is said to have been the hrst person ever to catheterize 
the male ureter in a living human being. He died suddenly at the comparatively early 
age of forty-one years, thus (Utting short a f)romising career in his chosen field, 
urology. 

Dr. Samuel Theobald (1846-lWO) was the son of a physician and was born in Bal- 
timore. .After graduating from the Cniversity of Maryland in 1867 he studied in 
Vienna and London and then returned to his native city. He was one of the founders 
of the Baltimore Eye, Ear and Throat Charity Hospital and served as Ophthalmic 
and Aural Surgeon to that institution. He is credited with having introduced the use 
of boracic acid in the treatment of infections of the eye. 

Dr. Robert L. Randolph (1861-1919) was also a Baltimorean and also prepared for 
his specialty by study in Vienna. Before entering the Cniversity of Maryland he took 
courses in physics, chemistry and biology in The Johns Hopkins Cniversity and after 
graduation in medicine from the Cniversity of Maryland took courses in pathology 
under Dr. Welch. He was a very effective teacher and carried a heavy burden of in- 
struction in the Hopkins School of Medicine. 

Dr. Robert B. Morison (1853-1897) was born in Baltimore and was the son of Na- 
thaniel Morison, the tirst Provost of the Peabody Institute of Baltimore. He too pre- 
pared for his specialty, dermatology, by studying in X'ienna, but unfortunately he 
died at the comparatively early age of forty-four years, and his connection with The 
Johns Ho[)kins Hospital was therefore brief. 

Of the five foregoing graduates of the Cniversity of Maryland who occupied re- 
sponsible positions in their respective fields in the Out-Patient Department of The 
Johns Hopkins Hospital during the first year of its existence, three attained pro- 
fessorial rank in the Hoj)kins School of Medicine after it opened in 1893 and the re- 
maining two would undoubtedly have done so had they lived a few years longer. 

There remains but one more Cniversity of Maryland graduate who contributed to 
the development of the Hopkins Hosi)ital and the Hopkins School of Medicine in 
their first years and therefore belongs on our list. I would place him at the top of that 
list because of the quality as well as the magnitude of his contribution to the Hopkins. 
I refer to Dr. John Whit ridge Williams, who was born in Baltimore (January 26, 
1866), obtained his A.B. degree from The Johns Hopkins Cniversity in 1886 and his 
M J3. from the Cniversity of Maryland in 1888. He may be regarded therefore as a 
joint alumnus of the two insilituions, and surely both can be proud of him. After post- 
graduate study in X'ienna and Berlin he returned to Baltimore and after serving as a 
voluntary assistant in (gynecology in the Out-Patient Department of The Johns 
Hopkins Hospital, was finally, in 1891, given a regular appointment in that division 



CHESXEY—U. 01- MI). MEDICAL SCHOOL AM) HOPKIXS 91 

in the Out-Patient Dei)artmenl. From that time until his death forty years later his 
entire professional career was devoted to the Hopkins. When the School of Medicine 
was opened in 1893 he was given the responsibility of teaching obstetrics to the medi- 
cal students and of organizing an independent obstetric service in the Hospital. In 
1899 he was made Professor of Obstetrics anfl in 1911 he was appointed Dean of the 
Hopkins ^ledical Faculty. He held that post until 1923, when he resigned from it to 
devote his entire time to the organization of the Hopkins r)e{)artment of Obstetrics 
on a full-time basis. He was an inspiring teacher, a successful administrator, the 
author of an outstanding text book and, at the height of his career, the leading obste- 
trician in the country. Perhaps you can understand now why I have saved him for 
the last of my story. 

Perhaps I may summarize that story very brietly by saying, as I did in the be- 
ginning, that the intiuence of the School of Medicine, University of Maryland, upon 
the initial development of The Johns Hopkins Hospital and The Johns Hopkins Uni- 
versity School of Medicine was manifested through some of its graduates who served 
on the first resident staff of the Hospital, and through others who contributed their 
ideas, their knowledge and their experience to the initial organization and develop- 
ment of the clinical work of the Out-Patient Department of the Hospital, and, later 
on, to the instruction of the medical students in the special medical lields which they 
cultivated. It was of great importance to both Hopkins institutions, the Hospital and 
the School of INIedicine, that they found ready at hand in Baltimore such competent 
and skilful physicians and surgeons who could help these two new enterprises in 
their formative years, and it is greatly to be hoped that the authorities of The Johns 
Hopkins Hospital and of The Johns Hopkins University School of Medicine will 
never forget that in the early days of both institutions their predecessors had the 
great advantage of being able to secure the services of some outstanding graduates 
of the University of Maryland to aid them in the development of the two institutions 
for which they were responsible. 



OBSTETRICAL CASE REPORT* 

X. E., a 19 year old, white, Para 0-0-0-0, was admitted on March 15th with right 
sided abdominal pain. She had her last menstrual period on September 3, 1956. She 
was then in her 27ih week of her tirst pregnancy. The pregnancy so far was unevent- 
ful. She was seen in the fourth month for prenatal care and internal examination 
showed some thickening in the right adnexa which was considered inflammatory- in 
nature. Xo actual history- of previous inflammation could be confirmed. Otherwise, 
her family and past history- was not contributor>'. 

On the morning of her admission date, the patient was in good health and swept 
the porch with a broom. Suddenly, she felt severe pains in the right flank which con- 
tinued to radiate in the epigastric area and in the inguinal region as well. The pains 
were not relieved by bed rest. In the early afternoon, the patient started to vomit, felt 
weak and cold. Because of continuous pain, she was brought to the hospital. 

On admission, the patient displayed the following signs: pulse 82; temperature 
99.8^; respiration 22, ^sith guarding of the right abdomen. The right leg was partially 
abducted. The fimdus was 17 cm. above the symphysis. The right comu was slightly 
above the fundus and difficult to outline because of muscular guarding of the entire 
right rectus muscle. The tongue was clouded. On auscultation, fetal heart tones were 
difficult to obtain but fetal movements were noted. The laboraton,- findings were: 
urine, albiunin and sugar negative; hemoglobin cotint 84%; WBC: 18,000. 

The presumptive diagnosis of twisted adnexal mass was made on the basis of his- 
tory, sudden onset, and continuation of pain. The patient was prepared for immediate 
surgerj'. 

OPERATIOX 

The abdomen was entered through a right upper transverse incision, cutting the 
rectus muscle. A fist-size, blackish-blue, cystic mass belonging to the right ovary 
was found. An elongated, enlarged right tube was wrapped around the cystic mass, 
with the pedicle, consisting of infimdibulopeh-ic ligament, ovarian ligament and 
medial ponion of the tube, twisted over 360" counterclockwise with complete oblitera- 
tion of the blood supply. A right salpingo-oophorectomy was performed. The appen- 
dix, which was slightly reddened, was removed by the usual technique. Care was taken 
that the uterus was not irritated by pushing, suturing or packing. 

The patient withstood the operation ver}.' well. The postoperative course was un- 
eventful. She was not placed on progesterone. 

PATHOLOGY 

The ovarian timior consisted of a gangrenous dermoid c>^st, including hair and 
sebaceous mass^. 

Postoperatiie follaiviip: The further prenatal course of this patient was uneventful 
and on June 10 she delivered at term, a full term living male infant of 7 lbs. 11 oz. 

* From the Department of Obstetrics and GNTiecoIogj-, The University- of Maryland School of 
Medicine. 

92 



OBSTETRICAL CASE REPORT 93 

by low forceps under saddle block. The mother and baby were discharged in 
good condition. 

DISCUSSION' 

Acute abdominal emergencies during pregnancy have to be operated on immedi- 
ately regardless of what stage of pregnancy they occur. A twisted ovarian cyst as 
the one described, constitutes an emergency comparable to an acute ap{)endicitis 
or an incarcerated hernia. 

If one tinds a freely movable ovarian mass in a nonpregnant patient, it should be 
removed even if asymptomatic because of the possibility of twisting or the possibility 
of being malignant. If such a cystic ovarian tumor is associated with pregnancy, the 
procedure is somewhat different. As long as the tumor is freely mobile, then surgical 
intervention should be delayed until at least after the fourth month. Operation be- 
fore the fourth month most likely will be followed by subsequent abortion. Ovarian 
masses should be removed, therefore, before the fourth month only, if they are in- 
carcerated in the small pelvis, together with a pregnant uterus. After the fourth 
month, most of the ovarian tumors are lifted out of the small pelvis, together with 
the growing uterus and they very often cannot be felt or found or are hidden in the 
tlanks or behind the uterus. Many of the ovarian tumors are not even found after 
labor. A freely mobile ovarian cyst during labor, high up in the abdomen, usually 
does not cause any trouble. Only if such a tumor is bound down in the small pelvis 
(tumor previa) are obstetric difficulties to be expected. Some of the ovarian cysts 
during labor can be carefully pushed upwards under deep anesthesia and the present- 
ing part subsequently descends into the pelvis and vaginal deliver}' can be accom- 
plished. If the tumor is fixed, aspiration of the contents of the cyst is sometimes 
possible, allowing subsequent vaginal deliver^-. However, abdominal deliver}' would 
be preferable in such a case with subsequent removal of the ovarian cyst. Frequently, 
ovarian cysts are bound down in the small pelvis and are adherent to the rectum 
and secondarily infected. 

Any ovarian tumor approximately 8-10 cm. in diameter or more, which is freely 
mobile or ver^- hrm on palpation, can be easily removed the first 24 hours post- 
partum. In the case described, circular movement of the abdomen when sweeping 
the porch had evidently caused the ovarian cyst to twist. The consecjuence was gan- 
grene of the dermoid. Postoperative prophylactic therapy with progesterone or 
relaxine may be beneficial but is still disputable. It is more im{X)rtant not to mis- 
handle the pregnant uterus during surgery and to avoid any pushing, packing or 
massaging. Immediate intervention, careful conser\'ative obser\'ation in the post- 
operative period are the essentials to keep the intrauterine pregnancy undisturbed. 



Bulletin of 

THE SCHOOL OF MEDICINE 

UNIVERSITY OF MARYLAND 

VOLUME 42 December, 1957 number 5 

FOREWORD 

The report which follows, for this School of Medicine is a first. It is, in effect, a 
summary by departments, covering the initial phases of a broad and continuing plan 
of development begun several years ago and which is now beginning to assume the 
appearance of a result tangible enough to be spread on the printed page. 

The report covers various phases of medical teaching and research developments. 
It carries announcements of appointments of many new faculty members who will be 
playing an increasing role in the progress of things in the years before us. Thus, the 
School of Medicine believes this time propitious to record such achievements as might 
be realized and to announce more formally its unified and detailed plans for the 
future. 

This annual report, which will become a continuing year-end number of the 
Bulletin, will present in some detail a summarv of the activities of the School as a 
whole (Report of the Dean) and of individual departments, reflecting their organi- 
zational activities, plans and achicx'cments. It will serve as a continuing and cumulative 
record of achiexement and also as a challenge for continued impro\emcnt. 



REPORT OF THE DEAN 

It has been said that we Hve in a competitive world. This truism is well recognized, 
but its extent is sometimes not appreciated. From the health viewpoint, from conception 
to the grave, man's very existence is being challenged by a host of living and environ- 
mental things, manv of which he is seldom aware. These conflicts, whether won or 
lost, materially affect his sense of well-being and his physical and mental ability to 
perform tasks that he deems essential. 

In the United States during the past yeiu the total expenditures for health services, 
both goxernmental and private, approximated seventeen billion dollars, including all 
forms of professional fees, hospital charges, nursing, drugs, appliances and other related 
items. It is worthy of note, however, that the amount spent on medical education itself, 
the most essential aspect of this whole program, was less than M of one per cent of the 
total. 

The keystone in the arch of adequate health services is the phvsician. There is no 
substitute for him and the only source of supply is the medical schools. Hence, medical 
education must be the concern of every segment of our society. At the University of 
Marvland we have followed very closely the guiding principles of the Association of 
the American Medical College, namely; 

"Medical education includes not only premedical preparation but also the subse- 
quent continuance of the educational process throughout the internship, hospital 
residency, specialty training, and the continuation education of physicians in practice. 
All features of the entire program must contribute also to the obligation of physicians 
to participate in the preparation, supervision, and guidance of the army of nursing, 
dental, public health, and technical workers and lay employees of health institutions 
and organizations as well as in the education of the public in health matters. The 
medical schools occupv the central position in the guidance and development of 
adequate health services of every kind and description for the entire population. It is 
a heavy responsibility. 

"The supply of doctors is under constant discussion. Attention may be called to the 
fact that 7,463 physicians were added to the profession during the calendar year 1956 
and 3,659 deaths were reported— a net increase of 3,804 doctors in the United States. 
It is vitally important to the future of the country that the recruitment and education 
of well-qualified students and physicians be maintained in order to insure adequate 
numbers for the future. 

"the medical school 

The medical school is always greater than the total of its parts. Its existence is 
justified to the extent that it maintains excellence in performance— education, research, 
hospital responsibilities, and public service. The primary function of medical education 
is to create an environment in which well-qualified students may acquire the knowl- 
edge, habits of study, basic skills, sound attitudes, sense of personal responsibility for 
patients, and an understanding of the professional, community, and the ethical prin- 
ciples that motivate the true phvsician. Manv of the features of practice, science, and 
communitv service cannot themselves be taught— thev haxe to be learned under the 
guidance of a competent and enthusiastic faculty. 



2 BULLETIN OF THE SCHOOL OF AIED/C/XE, L7. OF MD. 

"changes in medical education 

The rapidly moving developments are reflected in a changing philosophy of medical 
education. The new attitude is to regard it as a graduate discipline requiring integration 
of the entire learning process. The whole undergraduate medical course must be looked 
upon as a unit, not as a series of independent and more or less watertight compartments. 
This is a characteristic that distinguishes medical instruction from most other divisions 
of the university. The objective of the medical course is to produce upon graduation 
neither a specialist nor a physician who can render every t^'pe of professional care but 
rather one who, after an internship, is prepared to begin practice as a well-rounded, 
competent, safe, and conscientious family physician or to go forward into advanced 
work in a limited field. 

"Another feature of our present-dav educational plan is to select self-starting, self- 
directing, and self-propelling students who have a broad cultural background rather 
than a concentration in the sciences and who, under the guidance and supervision of 
skilled teachers, may secure the elements of a real education which, at the professional 
le\el, must always be largely self-education. In the instruction itself the emphasis is 
placed increasingly on the longitudinal nature of disease and the changes that occur 
in the individual throughout his entire life span rather than on the occasional acute 
illness or episode of disability. 

"new plans and methods 

Importance is increasingly being placed in the evaluation of the student upon his 
ability to think for himself; to demonstrate initiative, imagination, intellectual curiosity, 
scientific critique, and resourcefulness; to face alternati\'es and to make decisions; and 
to de\'elop understanding of diseases and of people rather than knowledge of them 
alone. The reliance is being placed upon performance, judgment, discrimination, and 
intellectual self-reliance which reveal the intangibles and imponderables that mark 
the true physician. 

"\Miile it is highly important that the purely intellectual talents of the student 
should be developed to the fullest, it is also vital that the qualities of temperament, 
human sympathy, and insight which are required for dealing with the manifold human 
problems of medical care should be emphasized. The physician needs an understanding 
of, and must be able to treat, the man as well as the disease. Probably no field of 
endeavor comes closer to the everyday problems of humanity than medicine."* 

The Universit)^ of Maryland. School of Medicine has followed very closely the 
ideologv' stated in the above paragraphs, and its medical educational program is a 
challenge to the faculty and, we hope, stimulating to the student. 

During the past year, the cost of medical education increased in keeping with 
generally rising costs. The average for all the medical schools in the United States, as 
compared with resources provided at the University of Maryland. School of Medicine 
are as presented in the following table: 

*From the Final Report of the AAMC Commission on Medical Education (1932). 



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REPORT OF THE DEAN 



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4 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

In rc\ic\\ing the happenings in tlic medical school of the 1956-57 school year, 
probably the most significant e\ent was the continuing organization of a strong faculty 
and an impro\ement in teaching in practicallv all departments. Through efforts of the 
faculty in securing grants-in-aid, as well as maximum use of the resources in the medical 
school and Uniyersitv Hospital, a great deal of new equipment and better research and 
teaching space haye been pro\ided. The diagnostic and research laboratories continue 
to be overtaxed and there is a great need for additional facilities if we are to give a high 
quality of patient care and provide adequate opportunities for research. In the clinical 
teaching in-patient areas, we ha\'e continued to have very inadequate representation 
of the medical specialties, which greatly weakens our teaching at both undergraduate 
and graduate levels. In the progress that has been made, the Medical School is very 
fortunate in that it has enjoyed the support and understanding of its problems by 
President Elkins and his staff and the Board of Regents of the University. 

As as mark of its maturity and growth, the Medical School continued its daily tasks 
of teaching, research, and patient care duly mindful of the future by making important 
changes and revision of its faculty Bylaws, the introduction of an Honor System by its 
student body and the opening of a new school of Physical Therapy. The format of its 
catalogue was changed and its courses of instruction developed in keeping with graduate 
education. 

Plant Improvevient 

A committee comprised of the Deans of the various professional schools has worked 
with the President's Office in drawing up the general requirements recommended for 
future development of the professional schools on the Baltimore campus. On June 18, 
1957 this plan was approved by the Board of Regents as a ten year objective of the 
Baltimore schools that would be sought from the State. The current year saw the 
initiation of construction through a Hill-Burton project involving the Radiology De- 
partment in University Hospital. The development of the obstetrics-gynecology service 
on the 6th floor of University Hospital with new delivery room, nursery and premature 
nursery, the conversion of the old obstetrics delivery rooms on the 7th floor of Uni- 
versity Hospital to operating rooms with movement of central sterile supply to the 
8th floor and the creation of recovery rooms in the area in the A wing of the 7th floor. 
In addition, the food ser\'ice facilities and cafeteria were revised in a major way. The 
E.E.G. clinic has been completely remodeled in the University Hospital and a sound- 
proof room pro\'ided for Otolaryngology with the help of the Woman's Auxiliary 
Board. Through the efforts of Dr. Harry M. Robinson, Jr., the Dermatology Clinic has 
been remodeled, making it possible to not only conduct the clinic in a better manner, 
but resources have been made a\'ailable for better dermatologic research. Generous gifts 
from the Filbert Foundation and the Woman's Auxiliary of University Hospital made 
it possible to install a Cobalt 60 radiation therapy unit for the treatment of cancer. 

In the medical school proper, the clinical pathology area and contagious areas of the 
5th floor Bressler Building have been converted into much needed research space and 
a new small animal room was started on the 4th floor of the Gray Building. In addition, 
major changes were made in the Bressler 6th floor surgical research laboratories. Clinical 
Pathology, Pathology and Microbiology laboratories were combined and the pathology 



REPORT OF THE DEAN 5 

laboratories changed in a major wav to allow better teaching, research and diagnostic 
work. The autopsy room was revised and air conditioned. Through the generous help 
of the School of Nursing, Bressler 2 lecture room was air conditioned. A steel stair was 
installed connecting the 4th floors of the Bressler and Gray Buildings giving better 
access to the small animal facilities. 

The Medical School received generous grants-in-aid from the United States Public 
Health Ser\'ice to provide an Ultra Centrifuge plus accessories and an electron miscro- 
scope. These instruments are now installed in the Bressler Building where they are 
used by most of the basic science departments. The Dean's Office in the old Medical 
Building has been renovated and restored to lines in keeping with the interior of the 
old building. Pending construction of the new Library of the University, the University 
moved the old library from Davidge Hall to 8 South Greene Street. Davidge Hall has 
been razed and two new pieces of property have been acquired to enlarge the site. The 
construction of the new librarv is expected to take place in the Fall of 1957. A delay 
in the construction of the Union Building is being experienced because the bids 
received have exceeded the money available for its construction. 

Faculty 

A number of new faculty appointments have been made in filling key positions. 
Dr. Harlan I. Firmingcr has been named to succeed Dr. Hugh R. Spencer in Pathology 
and Dr. Cyrus L. Blanchard has been named Chief of Otolaryngology. Dr. Firminger 
joins the faculty having previously been Professor of Pathology at the University of 
Kansas Medical School. He trained primarily at the Malary Institute in Boston with 
work also at Washington University Medical School in St. Louis and at the National 
Cancer Institute at Bethesda. Dr. Blanchard had his primary graduate training at the 
University of Michigan and at the University of California in Los Angeles. He is 
particularly well qualified in the areas of hearing and speech. Dr. Eugene Brody has 
replaced Dr. Maurice Greenhill as Professor of Psychiatry under Dr. Finesinger. Dr. 
Brody was Assistant Professor of Psychiatry at Yale Medical School in New Haven, 
Conn, prior to coming to Maryland. 

A series of social functions were held during the Spring in honor of Dr. Maurice 
C. Pincoflfs, who retired because of age on June 30, 1957. Dr. Pincoffs will remain 
with the medical school and will continue to serve on a part-time basis as a senior 
advisor and teacher in medicine and preventive medicine and rehabilitation. An 
interested group of faculty and alumni have headed a campaign to raise funds to 
establish a Maurice C. Pincoffs Fellowship in Medicine and an annual lectureship. 

Meethios 

During the year, a generous number of faculty participated in all the important 
national, scientific and professional meetings. Many of them contributed important 
papers to the programs. We were honored by the American Association of Anatomists 
in that they chose the University of Maryland Medical School for their annual meeting. 

During the year, a number of meetings and dinners were held marking the sesqui- 
centennial of the medical school, starting with the Founders Day Banquet on June 19, 
1957 and climaxed b\- precommcncement ceremonies on the grounds of University 



6 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

Hospital on June 8th. Dr. Alan Chesnev gave the precommencement address on the 
role of the LIni\crsit\ of iMar\hind facultv in the founding of the Johns Hopkins 
Medical School. 

A tea was given on December 18th in the old Medical School Building in honor of 
the passing h\ the legislature at Annapolis of the original act founding the Medical 
School. Friends in the State government and in the Universitv joined with us in tribute 
to this memorable event. 

Teaching mid Curr'iculnui 

The Facultv Board of the School of Medicine, upon recommendation of the 
Curriculum Committee, decided to extend the school year from 32 to 36 weeks. This 
increase in time was needed primarilv to proxide for elective time for the students and 
to give a more thorough coverage of such subjects as physical diagnosis. With the 
amount of information now available, it is impossible to thoroughly cover all subjects 
in the curriculum and wavs and means must be found to stimulate continuing study 
by the student of the medical sciences and related fields of knowledge. 

The problem of adequate coverage of the areas of knowledge involved in the 
curriculum is further compounded with difficulty by the fact that University Hospital 
has only 600 beds available for teaching and most of the clinical specialties cannot be 
basicalh taught from its clinical services and clinics. Although the school hours are 
from 8:00 A.M. to 5:00 P.M. five days a week and until 12:30 P.M. on Saturdays, we 
find great difficulty in arranging student schedules to cover the necessary clinical 
teaching areas. To carry out our present program, we find it necessary to teach, not 
only in University Hospital, but Baltimore City Hospitals, Mercv Hospital, Mount 
Wilson State Tuberculosis Hospital, Baltimore Eve and Ear Hospital, Kernans Hos- 
pital, Spring Grove and Springfield State Mental Hospitals, Fort Howard Veterans 
Administration Hospital and South Baltimore General Hospital. A great amount of 
student time is spent traveling to the various hospitals and it is difficult to provide 
adequate faculty supervision and teaching in so many widely scattered locations. 

ORGANIZATION OF THE CURRICULUM 

The curriculum is organized under fifteen departments. 

1. Anatomy (including Histology, Embryology, and Neuro-anatomv). 

2. Anesthesiology. 

3. Biological Chemistry. 

4. Medicine (including Medical Specialties). 

5. Microbiology. 

6. Obstetrics and Gynecology. 

7. Ophthalmology. 

8. Pathology. 

9. Pediatrics. 

10. Pharmacology. 

11. Physiology. 



REPORT Of THE DEAN 7 

12. Preventi\'e Medicine and Rehabilitation. 

13. Psychiatry. 

14. Radiology. 

15. Surgeiv (including Surgical Specialties). 

The instruction is gi\'en in four academic years of graded work. 

Several courses of studv extend through two years or more, but in no case are the 
students of different years thrown together in the same course of teaching. 

During the 1956-57 academic year, the first and second year curriculum was devoted 
principally to the study of the structures, functions, chemistry, pathology and patho- 
genic agents involved in the human body. This instruction was supplemented by an 
interdepartmental course entitled, "Man and his Environment". This course was 
directed toward an exploration of the sociologic, psychologic, physiologic and 
geneologic relationship of man and his surroundings. Outstanding national and inter- 
national figures in the areas of science invohed in the course were used as speakers and 
seminar moderators. 

Some introductory instruction in medicine, surgery and psychiatry is given in the 
second year. Laboratory work occupies most of the student's time during these two years. 

The third and fourth years are almost entirely clinical, but correlative medicine 
plays an important part in all instruction. During 1956-57 four weeks of additional 
instruction was gi\'en in the third year, thus providing more time for small group 
teaching, intimate contact with patients and correlative clinical and basic science 
conferences. A special feature of the instruction in the school is the attempt to bring 
together teacher and student in close personal relationship of a graduate teaching type 
in which the student is expected to expend a major effort in bringing about his own 
education and follow his thinking in the understanding of life and disease processes. 
In many courses of instruction, the classes are divided into small groups and a large 
number of instructors insures attention to the requirements of each student. Major 
curricular changes in the fourth year include free time for electives and the addition 
of the National Board Part II comprehensive examination to the criteria used for 
determinino cHuibiHtv for Graduation. 

In most courses the final examination is not the sole test of proficiency, and the 
students final grade is determined largely by recitations, comjiletion of assigned work 
and interim examinations given throuphout the course. 

The basic science departments are actively engaged in graduate education with a 
number of candidates for Ph.D. degrees. In addition, arrangements have been made for 
medical undergraduates to drop out one or two years and complete requirements for 
advanced degrees prior to completing their work for a M.D. In the areas of specialty 
training for graduates, the University Hospital is approved for surgery, neurosurgery, 
orthopedic surgery, g. u. surgery, otolaryngok)gy and chest surgery, internal medicine 
with subspecialties in cardiology, neurology and gastroenterology, pediatrics, obstetrics 
and gynecology, radiology, diagnostic and radiation therap\' anesthesiology, pathology 
and clinical pathology, psychiatry and clinical psychologv. 

The postgraduate program is aimed at public education in health matters and in 
bringing latest developments and necessary reviews to practitioners in the State. Short 



8 BIIIIETIN O/ ////: SCIIOOJ OF MUDICINE, II. OV MD. 

courses, seminars, spcci.il leetmcs ami (.onlcrcnccs arc provided lor County Medical 
Societies and hospitals witliin the State. 

Research and Stmlics l<> luijuovc Mcilicul liiliiailioii: 

During the \ear ending June .^0. I'-JS?, the School ol Medicine ohtained Irom 
sources other than its State hud^et i^ills and grants in support ol research anti studies 
for the imiiroxenient ol medical education in the amount ol S 1 ,485,728.00. Ihe year 
endinu June -lO, l'-)54 the amount reccixed lor these purposes was $530,162.00. Over 
the three \cars lajisin^ since 1954 research and studies tor the impro\'eincnt of medical 
education ha\'e increased dollar wise 280%— almost a three lold increase in three \ears. 

1 he interest to impro\e indiv idual accomplishment in amount and c|ualit\ is present 
in CN'erv department ol the medical school, in addition a concerted ellort is being 
extended by all to carr\ out research aimed at increasing medical and other scientilic 
knowledge as it alFccts health. /Mthough greatK handicapped h\ lack ol space and 
man\' times b\' cc|ui|')ment, medical research is blossoming in every department and 
maximum use is being made ol all the resources axailable. riie tradition and spirit oF 
the school today follows closely the lootsteps ol one ol its graduates, [anies C-arnii, who 
as a member of tbe United States /\rmv Commission succeeded in demonstrating the 
mode of transmission of xcllow fever. FIc became an eminent contributor to science 
by his investioations and a heroic benefactor of his coimtrN' and mankind. 

William S. Stone, Dean. 



BASIC SCIENCE DEPARTMENTS 
DEPARTMENT OF ANATOMY 

STAFF 

Frank H. J. Figge, A.B., Ph.D.. Profcssur of Aiiato}iiy & I lead of the Dcpartiuent 

Eduard Uhlenhutii, Ph.D., RL'sccirch Professor of Aiiatouiy 

Otto C. Brantigan, B.S., M.D., Professor of Clinical Anatomy 

Walle J. H. Nauta, M.D., Ph.D., (PT), Professor of Anatomy 

Vernon E. Krahl, B.S., Ph.D., Associate Professor of Anatomy 

Harry Patterson Mack, M.D., Associate Professor of Anatomy 

William Wallace Walker, IxS., M.D., (PT), Associate Professor of Clinical 

Anatomy 
Henriclis G. J. M. KuYPERS, M.D., Ph.D., Assistant Professor of Anatomy 
Theodore F. Leveque, B.A., M.S., Ph.D., Assistant Professor of Anatomy 
Karl Frederick Mech, B.S., M.D., (PT), Assistant Professor of Anatomy 
William Booth Settle, A.B., M.D., (PT), Assistant Professor of Clinical Anatomy 
Harry C. Bowie, B.S., M.D., (PT), Associate in Clinical Anatomy 
Ross Z. PiERPONT, B.S., M.D., (PT), Associate in Clinical Anatomy 
Herbert E. Reifschneider, A.B., M.D., (PT), Associate in Clinical Anatomy 
Robert Eugene McCafferty, B.S., M.S., Ph.D., Instructor in Anato^ny 
Elwyn a. Saunders, B.S., M.S., M.D., Instructor in Anatomy 
William A. Holbrook, B.S., M.D., (PT), Assistant in Anatomy 
Henry E. Langenfelder, B.A., M.D., (PT), Assistant in Anatomy 
Robert A. Moore, Jr., B.S., M.D., (PT), Assistant in Anatomy 

GENERAL POLICIES AND ORGANIZATION 

In accordance with the bykiws and constitution of the Medical School, the specific 
goals of the anatomy department during 1956T957 have been: 

1. To teach all branches of anatomy; gross, microscopic, neuro, developmental and 
clinical, to medical and graduate students. 

2. To carry on research to advance anatomic and general medical knowledge and to 
collaborate with other departments engaged in similar efforts. 

3. To foster and plan graduate work and, by selecting and encouraging the best 
students to engage in research, assist in the dexcloi^mcnt of medical educators in 
anatomic and other fields. 

4. To cooperate with all public health agencies and health organizations to dissemi- 
nate knowledge that has as its goal the improxement of the health of the people of 
the state and nation. 



10 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

ORGANIZATION OF COURSES AND TEACHING STAFF 

Anat()ni\ was taught as an integrated course with the needs ot the medical student 
having primary consideration. The teaching staff was divided into four groups or 
divisions as follows: 

1. Gross Anatomy 

2. Micro Anatomy and Embryology 

3. Neuro Anatomy 

4. Clinical Anatomy 

Since our primary obligation is teaching, this activity will be described first. 

TEACHING ACTIVITIES 1956T957 
GROSS ANATOMY 

In the division of Gross Anatomy, a dissecting manual was written in the attempt 
to design a schedule of dissections that could be accomplished in the 256 hours that 
was available for this course. This proved to be a far greater task than had been 
anticipated and occupied a major portion of the time of the head of the department 
from June until December. Doctors Krahl and Saunders and others also contributed 
considerable time in proofreading and correcting this manuscript. Approximately 500 
copies were printed by the Art Department. This manual will be used again next vear 
and after further correction and revision may be published if it proves satisfactorv. 

In Gross Anatomy Doctors Figge, Krahl, Mech, McCafferty, and Saunders had 
major responsibilities. Dr. Langenfelder and Mr. McDonald had minor responsibilities. 
Six members of the staff were present in the laboratory at all times. The major part 
of this course consisted in dissection of the human body according to a definite plan. 
This was accompanied by demonstration of dissected preparations and other materials. 
Television demonstrations were used whenever this appeared ad\'antageous. 

MICRO-ANATOMY 

In the 144 hour course in Micro-anatomy Doctors Mack, Leveque, and Figge had 
major responsibilities while Doctors Krahl, Kuypers, McCafferty, and Mr. Davidheiser 
had minor responsibilities. The subject matter in this course was correlated as closelv 
as possible with the material in Gross Anatomy. Special emphasis was placed on the 
dynamic and functional aspects. Audio-visual aids of all types were abundantly used 
in this course. 

Neuro-anatomy 

In the course in Neuro-anatomv, which extended over a period of 96 hours, Doctors 
Nauta and Kuypers had major responsibilities. Doctors Figge, Moore, Mack, and 
Mr. McDonald had minor responsibilities. This course covered both the gross and 
microscopic anatomy of the central nerxous system and was integrated as closely as 
possible with gross and micro-anatomy. 

CLINICAL anatomy 

The course in Clinical Anatomy was given over a period of 96 hours in the second 
semester of the sophomore year. This course is designed to bridge the gap between the 



DEPARTMENT OF ANATOMY 11 

basic anatomy and clinical anatomy as applied to the study and practice of medicine and 
surgery. It also affords the student a review of anatomy at the end of the second year 
just before the National Board Examinations. A prosection-guided dissection was carried 
out during the course. Dr. Brantigan and Dr. Walker had major responsibilities; 
Doctors Settle, Reifschneider, Bowie, and Picrpont, and Mr. McDonald had minor 
responsibilities in this course. 

COOPERATION OF OTHER DEPARTMENTS 

In carrying out the teaching program it was desirable, and feasible, to present some 
of the material in cooperation with appropriate clinical departments (Surgery, Roent- 
genology, Pediatrics, Neurology, and Neuro-Surgery). Consequently, in addition to 
the members of the anatomy staff that teach anatomy, there are numerous instances 
where members of other departments participated in the teaching of anatomy. Some 
of the more important areas where this was possible will be mentioned. 

1. In the field of roentgenology eight illustrated lectures were given by Dr. Boudreau, 
a member of the Department of Roentgenology. These were followed by demon- 
strations throughout the week of roentgenographs appropriate to the lecture and 
the parts of the body being studied. These films were arranged on sixteen view 
boxes in the Department of Anatomy by Dr. Boudreau. Appropriate structures to 
be identified by the student were marked by arrows. Later the correct answers were 
supplied so that students could gauge their progress and proficiency in this field. 

2. The Department of Neurology and Neuro-Surgery participated in teaching a course 
in Neuro Anatomy. 

3. The course in Clinical Anatomy was taught almost entirely by practicing surgeons, 
some of whom are members of the Department of Surgery. 

TEACHING IN OTHER DEPARTMENTS BY MEMBERS OF THE ANATOMY STAFF 

1. The anatomy staff takes an active interest in the Saturday morning course "Man 
and His Environment" and assumes some responsibility for this course. 

2. Dr. Krahl gave several lectures on the anatomy of the pelvis in the course in 
obstetrics and gynecology. 

3. Dr. Kuypers gave special instruction to groups of students and staff in the Depart- 
ment of Radiology on the anatomy of the central nervous system. 

4. Special lectures on the metabolism of porphyrins were given to the seminar groups 
in the Department of Medicine. (Frank H. J. Figge) 

5. This year, for the first time, we participated in teaching oncology to the sophomore 
students in pathology. This was primarily a special laboratory section on experi- 
mental cancer research. The department also furnished space and anatomic material 
for the teaching of anatomy to students in physiotherapy. (Frank II. J. Figge) 

GRADUATE AND POSTGRADUATE INSTRUCTION 

The Department of Anatomy teaches a small number of graduate students majoring 
in other basic science subjects in the Medical School. In addition, we have three 
graduate students majoring in anatomy. Approximately ten post-graduate students took 



12 mil lETIN or THE SCHOOL Of MEDICINE, U. OF MD. 

the course in .m.ilonn lor post ui;i(lu.ik' sluclcnls. This latter course is given in 
connection with Clinical /Xnatoniy. 

OPERATION or rilli ANAIOM^ HOARD OI- MARYLAND 

in connection with ihe teaching ol anatomy one ol the major lields of activity 
in\ol\es the procurement ol wood anatomic material lor teaching. I lie Anatomy ]>oarcl 
of Maryland was estahlisheil to lcL;ali/c ihc procurement ol such niaterial to he dis- 
trihuted to the medical and dental schools ol the state. 1 lowever, the actual work 
in\'ol\ed in collecting and disjXMisini; such material falls largely on the stalf of the 
Dcjxnlment ol Analonn ol llu- Llni\ersitv of Mar\land. It is necessary to maintain 
continuous contact with hosi)itals and ninsiny homes throughout the state. Durinu the 
past year we ha\'e tested a twenty-foin" hour answering service to estahlish whether 
this would improve' the ellicicncN of the /Anatomy Board, i his has not proved worth- 
while and will prohahK he ahandoned. 1 he factor which contributes most to the 
successfid collection ol anatomic material apjiears to he the establishment of good 
relations with the health authorities, llic hospitals, and the nursing homes. We have 
been able to elicit such a line spirit ol cooperation with these groups throughout the 
state that we ha\e a \cr\ adecjuate amount of anatomic material and are thus able to 
supply cadaxers to the dental school, the Ireshman and sophomore medical students, 
j)hysiothera|n students, and a small amount of material for some of the clinical 
departments in this and other hospitals. While this activity takes a considerable amount 
of effort on the part of members of this department (chiefly Doctors F'igge and Krahl), 
the situation in this school with regard to cadaver material is \er\ good and |K'rhaps 
far better than any other medical school in this country. 

In addition to collecting cadaver material considerable amount of time is s]ient in 
preparing some of this anatomic material for the use of students. The student bone 
loan collection must be continually added to for maintenance and improvement. Like- 
wise many preparations of great teaching value are prepared for our anatomic museum 
of which we are very proud. This was recently reorganized and refurbished for display 
at the meeting of the American Association of Anatomists. (Dr. Saunders, Mr. Carl 
Mueller) 

RESEARCH AcrivrriES and attendance at scientific meetings 

The research actixities of the department vary so greatly that this item will be 
discussed according to the indixidual members ol the department. 

Research Activities of Frank H. J. F/gge, Chairman of the Department and 
11. Patterson Mack, Associate Professor 

Since bcjth ol us are interested in the cancer jiroblem and collaborate so extensi\ely, 
it would be difficult to describe our research activities separately. As our work has 
progressed, we have come to recognize the fact that cancer is probably one of the 
constitutional diseases. It has thus been necessary to broaden our program to include 
constitutional diseases and study maladjusted or imbalanced states that bear a relation- 
ship not only to cancer, but also diabetes, obesity, cardiovascular, and other diseases. 
In carrying out these investigations we operate a relatively large mouse colony (8,000 



DEPARTMENT OF ANATOMY 13 

mice). The work is also extended to the chnical Held through the efforts of Dr. Mack. 
During the past year the following suhjects have received our attention. 

1. Use of Porphyrins in Cancer Therapy. 

There are two possible ways that the porphyrins may be used to improve the present 
methods of treatment of cancer. Because this material localizes in cancer tissue, and 
in lymph nodes, an attempt has been made to use this for the improvement of 
surgical therapy. In this case it is injected preoperatively and its fluorescent 
characteristics are used to assist the surgeon in determining the limits of the 
malignant tissue and also to locate nearby lymph nodes. While it has some promise 
in this field, the necessity for darkening the operating room and the elaborate 
equipment and preparations necessar)' have curtailed the use of this method. The 
second method of using porphyrin depends on its ability to alter the radiation 
sensitivity of any cell. This method is being used here in this institution and even 
more extensively elsewhere. Some remarkable early effects have been observed. 
Dr. Mack has submitted a comprehensive paper on this subject which will appear 
in the journal "Cancer" in the near future. 

2. The Studies on the Influence of Adiposity on Cancer Siisceptihility. 

It is well known that people who are overweight are more susceptible to cancer 
and manv other diseases than are thin people. We have developed a strain of 
naturally obese mice in order to study these problems. The mice have been inbred 
for over thirty generations. They exhibit a high incidence of obesity, but some of 
the mice in this strain are also normal weight and some actually thin. By hy- 
bridizing these mice with strains that carry factors for various types of cancer, such 
as mammary cancer and leukemia, we are able to introduce such cancer factors into 
the hybrid mice, which may then be classified as fat, medium, and thin for the 
purpose of studying the influence of weight on the cancer-producing factors. Since 
we had at hand a mouse exhibiting a high incidence of both mammary cancer and 
leukemia, we have used this strain to introduce these two types of cancer. The 
results are being recorded and tabulated. It is estimated that this experiment will 
require about another year to be completed. 

3. Studies of the Blood Sera of Mice of a High Leukemic Strain. 

In this laboratory the C3H strain of mice developed a high incidence of leukemia, 
which was superimposed on a high incidence of mammary cancer. The females of 
this strain now exhibit a 100 per cent incidence of cancer. Approximately 55 per 
cent of the females developed mammary cancer and 55 per cent developed leukemia. 
This means that 10 per cent of the animals developed both. This strain has been 
given the sub-strain designation, C.-jHk^-, by Dr. Law. In studying the blood sera 
of the mice of the CoHj.-;, and other strains. Dr. Andersch obser\'ed that there is 
a lower gamma globulin level in the sera of the CsHk^ than in the sera of mice 
of several other strains. The remarkable observation, however, was that the gamma 
globulin and alpha globulin of the leukemic mice were lower than the correspond- 



14 Bl/LLET/N OF THE SCHOOL OF MEDICINE, U. OF AID. 

ing fractions in the sera ot the non-leukemic mice of the CijHkr strain. These 
results are of interest in the Hght of previous and present work on the influence 
of hematoporphvrin and sunhght on gamma globuHn which was described by 
Dr. George Peck (unpubHshed). 

4. Liver Cancer, and Obesity. 

The mice of the fat mouse group arc also being used to study the susceptibility to 
cancer of the li\'er and pancreas and for longevity studies. We have the impression 
that many of the mice of this strain develop diabetes insipidus late in life, and this 
aspect of the problem is being studied in collaboration with Dr. Leveque. It is felt 
that there may be degenerative changes in the hypothalamus of these animals that 
involve the production and release of an anti-diuretic hormone by the neuro- 
secretory element of the hypothalamus. 

PUBLICATIONS 
Papers Suhmiited for Publication 
FiGGE, Frank H. J.; Davidheiser, Roger H.: Comparative studies on porphvrin-svnthesizing 
enzymes of harderian glands of mice of various strains. Submitted to Proceedings of the Society 
for Experimental Biology and Medicine. 

Papers Accepted for PuhJication 

Mack, H. Patterson; Diehl, Wm. K.; Peck. George C; Figge, Frank H. J.: Evaluation 
of the combined effects of hematoporphvrin and radiation I. Treatment of carcinoma of the cervix. 
Accepted in Cancer. 

Papers Pithlished 

Peck, George C; Mack, H. Patterson; Holbrook, William A.; Figge, Frank H.J.: Use 
of hematoporphyrin fluorescence in biliary and cancer surgery. The American Surgeon, 21. 

Figge, Frantc H. J.; Mack, H. Patterson; Peck, George C. and Holbrook, William: Use 
of red-fluorescent porphyrins to delineate normal and abnormal anatomical structures and neoplastic 
tissues in human subjects. The Anatomical Record. 121. 

Davidheiser, Roger H. and Figge, Frank H. J.: Enzymatic porphyrin synthesis in harderian 
glands and other organs and tissues of mice. Proceedings of the Society' for Experimental Biology 
and Medicine. 

Figge, Frank H. J.; Diehl, W. K.; Peck, George C. and Mack, H. Patterson: Evaluation 
of the use of intravenous hematoporphyrin injections to improve surgical and radiation therapy of 
cancer in human subjects. Proceedings of the American Association for Cancer Research, 2. 

Figge, Frank H. J. and Wichterman, Ralph: Influence of hematoporphyrin and phenol on 
x-radiation sensitivity of paramecium. Biological Bulletin, III. 

Solomon, Harvey M. and Figge, Frank H. J.: Difl^erential concentration of porphyrin in 
various divisions of the central ner\'ous system. Proceedings of the Society for Experimental Biology 
and Medicine. 

Figge, Frank H. J.: Cigarette smoke and cancer. Medical Science, 1. 

Research Activities of Dr. Eduard Uhlenhuth, Research Professor of Anatomy 

Dr. Uhlenhuth is interested in depicting the anatomy of the pelvis in a more precise 
way than has ever been accomplished before. His work in\'olves the careful dissection 
of the fascia and other structure of the pelvis so that they may be accurately illustrated 
by an artist. He has published a book entitled "The Anatomy of the Pelvis", which is 



DEPARTMENT OF ANATOMY 15 

widely recognized and acclaimed by gynecologists in this and other countries. Another 
more complete book is being prepared on this same subject. This, as well as the one 
which preceded it, will probably become classics in this field. In addition. Dr. Uhlen- 
huth has published the following papers during this year. 

1. A paper which lists the old books and classics ot anatomic literature which he 
collected during the time that he was chairman of the department. "The Collection 
of Classics of the Anatomic Literature in the Library of the Department of 
Anatomy". Bulletin of the School of Medicine, LIniversity of Maryland. This 
collection also was presented as a demonstration in the symposium on the History 
of Anatomy at the 70th meeting of the American Association of Anatomists held 
here in April. 

2. In collaboration with Dr. Gladys E. Wadsworth he has published a paper entitled 
"The Pelvic Urethra in the Male and Female" in the Journal of Urology. 

3. "Vaginal Fascia, A Myth?" by Eduard Uhlenhuth and Gretchen Wood Nolley. 
Submitted to Obstetrics and Gynecology to appear in the October issue as the lead 
article. 

Research Activities of Walle ]. H. Nanta, Professor of Anatomy, and 
Henricus G. ]. M. Kuypers, Assistant Professor of Anatomy 

Doctors Nauta and Kuypers also collaborate extensively in their investigations on 
the morphology and function of the central nervous system. Their investigation in\'olves 
chiefly the production or study of the result of lesions in the central nervous system 
by means of a method developed by Nauta and Gygax, which depicts degenerative 
changes in unmyelinated and lightly myelinated nerve fibers. Dr. Nauta was invited 
to present his work at the International Symposium on the Reticular Formation held 
in Detroit. At this meeting he and Dr. Kuypers were co-authors on a paper entitled 
"The Anatomy of the Ascending Fiber Systems in the Reticular Formation". They 
both presented their work also at the meeting of the Cajal Club, which met here at 
the University in April. The complete list of publications of Dr. Nauta is not available 
at this time. Dr. Kuypers has an independent interest in the analysis of the cortico 
bulbar connections and the phylogenetic trends in this part of the nervous system. 
His activity in this field is expressed by the following papers accepted and submitted 
for publication. 

1. "The Anatomical Analysis of Cortico Bulbar Connections in the Cat". /\cceptcd 
and published in the Journal of Anatomy. 

2. "Cortico Bulbar Connections in Man". An anatomical study submitted to Iirain. 

3. Dr. Kuypers attended the 1st International Congress of Neurological Science held 
in Belgium. Here he presented a paper in the session on extra-pyramidal path- 
ology entitled "Phylogenetic Trends and Representation of Motor Mechanisms in 
the Cerebral Cortex". He also presented an exhibit at the International Neuro- 
logical Congress on the "Nauta-Gygax Selective Silver Impregnation Method for 
Degenerating Nerve Fibers Applied to Himian Material". 



16 BULLETIN OF THE SCHOOL OF MEDICINE, L/. OF MD. 

Research Activities of Veiiwii E. Krahl, Associate Professor of Anatomy 

In addition to considcrai^le responsibility in the teaching program in gross anatomy, 
histology, and embryology, and obstetrics and gynecology, Dr. Krahl is active in a 
research program which inyoKes the investigation of the finer structure of the 
mammalian lung. The specific problems being investigated at this time are: 

1. riic Development <md Arrangement of Elastic Fibers in the Lungs of Man and 
Lower ALunmals; their Changes with Age— Possible Relationships to the Problem 
of the Etiology of Pulmonarx' Emphysema. 

2. Stud\ of a recentK' disco\'ercd lironchiolc-ahcolar communication in the lungs of 
man and lower mammals— a comparati\ e anatomic stud\ . 1 he novelty of such a 
finding and the practical use of the knowledge of such pathways of collateral 
aeration warrants further study. 

3. Construction of apparatus, adapted for lungs of xarious size for the inflation of 
lungs under subatmospheric pressure with fixatives, heparinized blood plasma, etc. 
Dr. Krahl presented some of the results of his investigations at the 6th Liternational 

Congress of Otolaryngology here in Baltimore, May 1957. Dr. Krahl has also published 
numerous book re\'iews in the Journal of American Dental Association and the Annals 
of Liternal Medicine. 

Research Activities of Theodore F. Leveque, Assistant Professor of Anatomy 

Dr. Leveque is profoundly interested in investigation of the neurosecretory process 
in the nerve cells of the hypothalamus. He has been here just long enough to initiate 
experiments in this field which are under-going analysis at present. Last spring he was 
invited to discuss papers at the symposium on the diencephalon at a meeting held in 
Milan, Italy. 

Research Activities of Robert E. McCafferty, histriictor in Anatomy 

Dr. McCafferty is interested in the dynamic aspects of amniotic fluid exchange 
and maternal fetal exchange in general. He has presented some of this work at the 
meeting of the American Association of Anatomists last year. His paper was entitled 
"Localization of P32 Injected Intraperitoneally in the Fetal Mouse". He also partici- 
pated in a group discussion by invitation at the 1st International Congress on Develop- 
mental Biology at Pro\'idence, Rhode Island. The subject was "Phosphatase Need of 
the Embryo". 

Research Activities of Ehvyn Saunders, histriictor in Anatomy 

Dr. Saunders is j:)rimarily interested in hyper-tension and cardio-\'ascular research. 
He has started a project which inxolyes the perfusion of human organs obtained at 
autopsy to obtain quantitatixe data on size variation of the vessels which form the 
arterio-venous connections. He is also interested in utilizing methods of direct ob- 
ser\'ations of blood vessels. Another interest of Dr. Saunders is to assist in the develop- 
ment of motion pictures of dissection procedures in order to improxe the efhciencv of 
the teaching of gross anatomy. 



DEPARTMENT OF ANATOMY 17 

ATTENDANCE AT NATIONAL AND INTERNATIONAL SCIENTIFIC MEETINGS 
AND PRESENTATION OF PAPERS BY ANATOMY STAFF MEMBERS 

L 69th Annual Meeting of the American Association of Anatomists at Marquet University, 
Milwaukee, Wisconsin. Doctors Figge, Nauta, Kuypers, Mack and McCafferty presented 
papers. Doctors Krahl, Leveque and Saunders attended this meeting. 

2. Symposium on the Use of Hematoporphyrin and Radiation Therapy of Cancer, University 
of Minnesota, Minneapolis, Minnesota. Attended by Doctors Figge and Mack for the purpose 
of participation in the symposium. 

3. The National Cancer Conference sponsored by U. S. Public Health Service and the 
American Cancer Society, Detroit, Michigan. Attended by Doctors Mack and Figge. 

4. Yearly meeting of the American Cancer Society, Scientific and Business Meeting of the 
American Cancer Society, New York. Dr. Figge attended this meeting as the delegate member 
from the Maryland Division of the American Cancer Society, November 1956. 

5. Ross Symposium, March 29, 30 in Baltimore, Maryland. Discussion of Doctor Schwartz's 
paper on Porphyrin Metabolism by Dr. Figge. 

6. International Cytology Cancer Conference under auspices of the Southern Society for Cancer 
Cytology, Miami, Florida, April 25 to 29. Attended by Dr. Figge to discuss papers of South 
American visitors or guests. 

7. International Symposium on the Reticular Formation, Detroit, Michigan. Attended by Doctors 
Nauta and Kuypers who gave a paper and participated in the discussion. 

8. Meeting of the American Society for Cancer Research, Atlantic City, April 1956. Attended 
by Doctors Figge and Mack, who gave papers. 

9. First International Congress of Developmental Biology, Providence, Rhode Island. Attended 
by Dr. McCafferty to participate in a symposium on "Phosphatase Need of the Embryo". 

10. Federated American Biological Societies, Atlantic City, April 1956. Attended by Doctors 
Mack, Figge and McCafferty. Dr. Figge discussed a paper co-authored by Dr. Andersch. 

11. Si.xth International Congress of Otolaryngology, Baltimore, May 1957. Dr. Krahl presented 
a paper on "Anatomy of Terminal Airways". 

12. American Medical Association Annual Meeting, New York City, June 1957. Attended by 
Dr. Krahl. 

13. 1st International Congress of Neurological Science, Brussels, Belgium. Attended by H. Kuypers 
to give a discussion and demonstration. 

HOST TO MEETINGS OF THE AMERICAN ASSOCIATION OF ANATOMISTS 
AND RELATED SOCIETIES AT THE UNIVERSITY OF MARYLAND 

Probably the most time consuming and extensixe activit\ with regard to scientific 
meetings inxoKed phiying host to the meeting of the American /Vssociation of 
Anatomists and the Histochcmical Society, the Tissue Cuhure Society and the Cajal 
Club. The invitation to meet here was accepted at the end of a four xear period of 
service on the exccutixe committee bv Dr. Figge. ApproximateK' 1500 people attended 
these meetings, while practically everyone in the department, and in the department of 
anatomy in the Dental School, others on the faculty and nian\ of the students 
participated in this program. Certain members of the staff of the Anatom\' Department 
deserve special mention because of the great amount of effort expended in making 
this meeting a success. In particular, Dr. Krahl deserves mention for the excellent 
manner in which he managed the commercial exhibits. He and Dr. McCafferty also 
handled the ad\ance registration and registration desks during the meeting. Dr. Mack. 



18 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

with the assistance of a iclati\cl\ hiruc number of students, did an excellent job of 
managing the scientific demonstrations and the exhibits of teaching aids and the 
historic exhibits. Dr. Leveque, with the assistance of others on the staff and a number 
of students, had charge of the meeting rooms and projection and turned in an excellent 
performance. Dr. Saunders had charge of check rooms and signs. He and Dr. 
McCaffertx also had charge of the motion picture program including projection of 
motion pictures. While this meeting took a considerable amount of our time for 
approximately an eight month period and delayed some of the research work of some 
of the members, we nevertheless felt that it was a very successful meeting and that 
through it we made a good impression for the University of Maryland on the anatomists 
throughout this country and Canada. 

The Tissue Culture Association, the Cajal Club, and the Histochemists arranged 
their meetings to follow in the same week as the anatomists meetings. We also played 
host to these associations. The entire program of the Histochemists was tape recorded. 
Doctors Nauta and Kuvpers participated actively in arranging the meeting of the 
Cajal Club and both gave papers at this meeting. All of these meetings were well 
attended and the members appeared to be pleased with the arrangements. The 
Biological Stain Commission, which sometimes meets with the anatomists, also met 
just before the anatomical meetings, because Dr. Figge was the retiring president. 

GRANTS-IN-AID OF RESEARCH RECEIVED BY VARIOUS MEMBERS OF 
THE DEPARTMENT OF ANATOMY 

Dr. Frank H. J. Figge: Anna Fuller Fund for Cancer Research $ 2,500.00 

U. S. Public Health Service, "Influence of 
Hematoporphyrin and Sunlight on Anaphy- 
lactic Shock" .' .'. 5,502.00 

The American Cancer Society "Obesity and 

Cancer" .' 6,480.00 

Dr. H. Patterson Mack: American Cancer Society, "Influence of Hema- 
toporphyrin on Radiation Treatment of Cancer" 5,500.00 

Dr. Ediiard llhlenhuth: Investigation on Pelvic Anatomy, U. S. Public 

Health Service 5,000.00 

Dr. Vernon E. Krahl: "Finer Structures of the Mammalian Lung", 

U. S. Public Health Service 4,469.00 

Dr. H. G. J. M. Kuypers: U. S. Public Health Service, "An Anatomical 

Study of the Ascending Connections of the 

Brain Stem Reticular Formation" 6,099.00 

"Cortico Fugal Connections to the Pons and 

Lower Brain Stem" 6,000.00 

Dr. T. F. Leveque: U. S. Public Health Service, "Investigation of 

the Neuro-Sccretorv Processes in the Flyop- 
thalamus" 5,400.00 

Dr. Robert McCaflFertx : U. S. Public Health Service, "Amniotic Fluid 

Flow in the Fetal Mouse" 1,100.00 

$48^050^ 



DEPARTMENT OF ANATOMY 19 



SPECIAL GIFTS 



Benjamin Green Foundation, to purchase special instruments for research 

program of Dr. Figge $ 1,500.00 

OTHER ACTIVITIES 

Finally, it should be mentioned that all of the members of the staff participate in 
numerous committee meetings. Whenever requested, we plan programs for the Uni- 
versity of Maryland TV program. This year we presented a TV show on the History 
of Teaching Anatomy at the University of Maryland. This same material was pre- 
sented by Dr. Figge with the assistance of a number of the medical students at the 
anatomists meeting as a demonstration which utilized effectively the secret stairways 
and dissecting rooms of the old medical school building. 

Most of the anatomv staff also engages in certain extra-curricular activities that 
have to do with speaking in public meetings of various civic groups and organizations. 
Probably the chief burden in this respect, however, was carried by Dr. Figge, Chairman 
of the Department, who bv \'irtue of the fact that he was president of the Biological 
Stain Commission, and is president of the American Cancer Society, assumed a fairly 
heavv load of obligations along this line. To illustrate this point, the number of personal 
appearances at public gatherings in connection with the presidency of the American 
Cancer Society for the first six months of this year were tabulated by checking the 
calendar of appointments. Twenty-five such engagements were recorded on the calendar 
between Januarv 1 and June 30, and included such items as presiding at cancer 
executive committee meetings, campaign luncheons, after dinner speeches at various 
organizations, TV and radio appearances. The twentv-five appearances in six months 
averages one per week and includes three TV shows and three radio transcriptions. 

GENERAL DISCUSSION OF THE PRESENT STATUS AND 
FUTURE NEEDS OF THE DEPARTMENT 

STAFF 

In general, it is felt that the anatomy staff is adequate in spite of the fact that one 
instructorship remained unfilled. This position remained open, not because there was 
no candidate for it, but it is felt that until the right person can be found it should 
not be filled. We now have an extremely compatible and homogeneous group and we 
feel that any additions must be made very carefully. 

SPACE 

During the year we have voluntarily given up to other departments considerable 
space that has been used by the Anatomy Department. The room in the Gra\- Building, 
which has been used in teaching nurses anatomy, was allocated for a general mouse 
colony. Room 118 was temporarily allocated for an experimental electro enccphalo- 
graphic research room for Dr. Merlis. A suite of rooms consisting of a laboratory, oHice, 
and darkroom was allocated for an electron microscope area to be used jointly bv the 
departments of Microbiology, Pathology, Anatomw and others. There are still some 
rooms, howe\'er, that are not as useful as could be because the furnishings are inade- 



20 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

quale and inappropriate. It is planned to remedy this eondition in the near Future 
because we are in great need of more room for graduate student work and summer 
medical student fellowships. It is also planned to reorganize the bone room area in the 
Gray Buildino; and move the present shop from the Bressler Building so as to create 
additional space for graduate students and research facilities. 

This year has been a very busy year. It is evident that the Anatomy Department 
carries a heavy teaching load and the research program is also very active. The summary 
of the amounts of grants-in-aid shows that there are ten projects supported by outside 
agencies with a total budget of almost $50,000. This is approximately one-half of our 
State salary and operating expense budget. 

It is \'ery necessary for this department to operate twelve months of the year. The 
research program could not be effectively pursued with any other plan. In addition, 
the reason we must oj^erate on the twelve-month plan is because people die throughout 
the year and a considerable portion of our total operation depends on obtaining a 
sufficient amount of this anatomic material. 



DEPARTMENT OF BIOCHEMISTRY 

Operating Plan and Ideology 

Each staff member takes charge of laboratory and lecture material in the areas 
in which he has had special training. This responsibility may include graduate, 
medical, pharmacy and nursing students. The balance ot each man's time is 
de\'oted to research on problems of his own selection. 

Medical Biochemistry 

Basic biochemical principles are frequently supplemented by clinical observa- 
tions by members of the hospital staff. Concurrent scheduling of physiology and 
biochemistry has encouraged intimate integration of the two subjects. 
Pharmacy Biochemistry 

Pharmaceutical principles are avoided. Instead, emphasis is placed upon the 
blood and urine chemistry and other clinical material in order that the future 
pharmacists may better understand the problems of the physician. 
Nursing Biochemistry 

Emphasis is placed upon clinical aspects of biochemistry so that the nurse may 
be better prepared to perform her hospital duties. 



Facidty and Staff 

Schmidt, Emil G. 
Herbst, Edward J. 
Vanderlinde, Raymond E. 
Vasington, Frank D. 
Brown, Ann Virginia 
Parker, Arlie B. 
Councill, Flo M. 



Professor and Head of Department 

Associate Professor 

Associate Professor 

Assistant Professor 

Instructor 

Jr. Instructor 

Research Assistant 



3. Teaching 

Graduate students— see "5" below. 

Medical students— Biochem. 101 8 credits 

Pharmacy students— Biochem. 153 5 credits 

Nursing students— Biochem. 1 3 credits 

4. Research 



1 10 lectures+192 hours lab. 
64 lectures-!- 128 hours lab. 
40 lectures-f- 20 hours lab. 



The following research programs ha\c been continued during the 1956-57 
fiscal year: 

Schmidt, Emil G.— The effect of antibiotics on the products of intestinal 

putrefaction in the rat. 
Herbst, Edward J.— Polvaniinc metabolism in microorganisms, animal and 
human tissues. 



21 



22 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

Vanderlinde, Ravmond E.— Pituitary gonadotropic release agents. 
Vasington, Frank D.— Estrogen metabolism. 
All of the above research programs have been supported in large measure by 
outside grants which totaled $19,000. 

5. Graduate Program 

Courses given : 

Biochem. 208— Chemistry and Metabolism of Steroid Hormones 

3 credits 32 hours. 
Biochem. 205— Seminar (Radiobiochemistry) 1 credit 16 hours. 
Biochem. 203— Research credit proportional to work accomplished. 
In addition to teaching and directing the above courses, the staff supervised 5 
advanced degree candidates who are majoring in biochemistry and 5 advanced 
degree candidates minoring in biochemistry. 

6. Statistical Analysis and Work Done and Service Rendered 

None 

7. Facilities and Eqiii'^wient 

a. Facilities 

1— student laboratory accommodating 50 students at a time. 
1— large and 2 small research laboratories. 
1— balance room. 
1— small departmental library. 
2— private offices. 
1— janitorial supply room. 
1— stockroom and preparation room, 
—storage room in attic. 

b. Equipment 

Usual laboratory and office equipment and following special items: 

( 1 ) Sharpies, International, International refrigerated and Servall centrifuges. 

(2) Deep freeze, ice storage chest, walk-in cold room, walk-in warm room, 
3 small refrigerators. 

(3) Beckman Model DU Spectrophotometer, photometers. 

(4) Sonic disintegrater. 

(5) Fraction collector. 

(6) Analytrol. 

(7) Marchant calculator. 

(8) Paper electrophoresis. 

(9) Semi-micro balance. 

(10) Constant temperature bath. 

(11) Warburg. 

(12) 50 animal cages. 

(13) Scaler and counter for isotope work. 



DEPARTMENT OF BIOCHEMISTRY 23 

8. Community Service 

Active participation in local scientific societies. Lectures to local medical groups. 

9. Publications 

Schmidt, E. G.; Gardenier, Jean; Kessler, G.: Effect of chemotherapeutic agents on 

nitrogenous and phenolic constituents of rat urine, Bull. Sch. Med. U. of Md. 42, 6, 

1957. 
Kessler, G.; Schmidt, E. G.; Vanderlinde, R. E.: EfFect of feeding ether extracts of hydro- 

lyzed human urine on growing rats, Btill. Sch. Med. U. of Md. 42, 12, 1957. 
Schmidt, E. G.; Kessler, G.: Microbiological determination of aromatic acids in the urine 

of white and negro adults, /. Lah. & Clin. Med. 50, 282, 1957. 

10. Recomviendations for Improvement 

a. It is expected that the balance room and janitorial rooms will be converted 
into radioisotope and metabolism laboratories, respectively. It will be necessary 
to equip these laboratories in the coming year. 

b. New experiments involving radioisotopes are being planned for our students. 

c. Lecture and laboratory course in radiobiochemistry to be developed for graduate 
students. 

d. Additional animal and research facilities are desirable. 

e. Air conditioning of research quarters is highly recommended. 

f. Additional research facilities for graduate and postdoctorate training are badly 
needed. 



DEPARTMENT OF MIC^ROBIOLOGY 

1. Goicriil sliilciiwiit of ojH'rdtiiii^ fldii tiinl iclcaloj^v. 

1 he mission ol tlic l)c'|)ailinc'nt ol MiciohiolouN ol tlic Medical School may 
be summari/ecl in the h)llowino statements: 

a. To imjxirt basic inlormation i\u(\ iMiclerstanchn^ in the fields ol microbiology 
and immunology to medical students, house officers, and practicing physicians 
in such a way as to |)rovidc them with the knowledge and concepts necessary 
to meet the challenges of medicine, infectious disease, public health and 
preventive medicine. 

b. To recruit and educate scientists and academicians in the lields ol microbiology 
and immunology through graduate, |)()st graduate and lellovvship jirograms. 

c. To advance the knowledge in the held through an active research |)rogram, and 

d. To advise local, state and Federal authorities on matters which fall within the 
scope of our field and to participate in educational, scientific and medical 
matters at all levels. 

Since the Fall of f954, a concerted ellort has been made to lullill these missions 
and resj^onsibilities. This has entailed revision ol the teaching program, accpiisition 
of new stall, improvement of |)hysical facilities, recruitment of funds from outside 
sources, and institution of a comprehensive research j^rogram. I he helpful and 
strong administrative support from the Dean's Office and the wholehearted co- 
operation of colleagues in other dejxirtments has been of inestimable aid. It is our 
opinion that some measure of progress has been made in these directions. Needless 
to say, continued effort will be recpiired over several more years to bring the entire 
program to a more comi^lete state of maturity. Nevertheless, it is with some pride 
that we can state that this department is developing a teaching program for medical 
students which is in step with the most progressive in the countrv; that it is 
becoming known at local, national, and international levels lor its research pro- 
gram; that it |K'rforms advisorv functions at the level of the federal and state 
governments; and that it partici|)ates in the functions ol such educational and 
examining bodies as the National Board of Medical lixaminers. Details apjiear in 
the subse(|uent sections. 

2. Facitltv and staff. 

During the |')ast year, the faculty of the Department of Microbiology has 
consisted of the following persons: 

Charles L. Wisseman, Jr., M.D. Professor and Head of the Department 

Andrew G. Smith, Ph.I^. Assistant Professor 

Benjamin 11. Sweet, Ph.D. Assistant Professor 

Merrill J. Snyder, Ph.D. Assistant Professor 

I lyman E. Levin, M.D. Associate (Part-time) 

Elizabeth C. Heinz, B.A. Assistant Instructor 

25 



26 nUlLF.Tl\' or Tlir SCllOOl ()/ .M/-/)K'/\K. L/. ()/• A/D. 

At the beginning dI this llsc.il xc.ii. I)i. 1 (.Iw.inl Siocis, Associate Prolcssor. Iclt 
the Department to take a jX)sition at the Uni\ersit\ ol Peniis\ 1\ ania. Reeniitinent 
tor replacement is acii\el\ proceeding. 

This laciih\ has serxetl laitlilulK ami t'lithiisiasiicalU in tlischaii^ini; its 
teaching responsihilities. i\e\erlheless, some comments are in onler reganling the 
status of the laeuhN. Dr. Sn\(.ler. who hoKls a teaching appointment in this 
department, is sup|H)iietl cnlircU h\ the Dcpaitnuiu ol XKnlicint' aiul it is through 
tlie generosit\ ol the Department ol Medicine that l)i. Sn\tlcrs services are matle 
availahie to the De|iartment ol Microhiologx . I lis \aliiahlc participation in the 
artairs ol this tlcpartmcnt is limilctl to the leaching ol the course in mctlical micro 
hit>log\ lor the medical students and tKies not extend to the research and other 
liuictions ol the department. Dr. Sweet originalK joinetl the de|iartment on a 
research pro)cct. 1 lo\\c\ei, he has show n keen interest in the te.ichinL; |Mdgram aiul 
has j^roxed to he a \er\ \aluahle asset. Dr. Sweet is now lullv integrateil into all 
limctions ol the department. Dr. I e\in. who has been associ.ited with the depart- 
ment loi- man\ \eais, seixes lailhlulK in ihc ic.ichini; progi.nn .uul is a \aluahle 
asset in the student lahorator\. Ag.un, the nature ol his appointment |irohihits his 
partici|iation in the research ami most other I unctions ol the tlepartment. Dr. 
Smith has hecn promoted to the rank ol Associ.ilc Proli^sor, elK\ti\e lul\ I, in 
recognition ol his res|ionsihle position in liic tlcparlmcnlal teaching program. 

In evaluating the atlei|uac\ ol this lacultv lor ilu' (.xeculion ol the (nerall 
missions ol the tlepartment, the lollowin^; ohseix alions wcniKl appear appropriate: 
O) \\ hen the remaining open |iosition is Idled, the l.ieullv would appear nearly 
adequate to cover the lecture portii>n ol the course in mctlical microhiologv; 
(2) Even with this position Idleti, the instructor sluilenl ratio is less than optimal 
lor best results in the stutlent laboratoiv undi-i- present comlitions; (3) Only a 
part ol the lacultv listed above is available lor p.nticipalion in research activities, 
graduate and jxist graduate training and other ilepartmental functions. 

I he remaimlei ol the stall, which consists ol I! imlividuals empKned on a 
classilied basis, will not be listctl iiuliv iiluallv . I hev l.ill into the lollowing cate- 
gories: (1) Technical assistants supporting teaching .uul research ellorts; (2) 
Secretarial assistance; (3) Prep.ii.iiion looiii |XMsonnel; (^4^ /Vnimal caretakers; 
and (S^ janitorial assistance. /Mmost h.ill ol these |KMsons are currcntb' supported 
bv research contracts and grants derived I rom sources outside the regular budget. 
The jireparation room am! the ain'mal laeilities. because ol increased dcmamls I rom 
teaching antl research aetiv ities, aie in particular need ol additional personnel. 

3. Teaching Prugnwi 

The major teaching elVort of this department goes into the course on medical 
microbiologv lor the medical students. In addition to this, other courses are ollered 
as a part ol the graduate training program. I inillv, members ol the department 
participate in teaching sessions sponsored b\ other departments w iiliin the school 
and at various hos|-)itals and institutions outside the school. 

a. Medical Microbiolouv 



nii'Ai'.iMiNr or mk I'.oiuoi ocy 27 

I lie ;M(;it(-,l iiiiili<(| d* |»;ii Inn nl.il l<;i( liiir'_ cdoi I ;'/i''. ml') tie ( oiicc in 
;nc(lit;il ini( rohiolo^y gi\iii to the •,t>\)\uiiut)U' '.(iidcni', in lln- I :ill ■,< inc.ti t i,\ 
cacli year. I liis (omsc was lorincrly ^ivcn lliioiij'Jioul iIh ycai, llic lii-.l 
semester was dcvolcd lo Ijaclcriolo^y and tlic -.((ond •.(■nic'.lct lo ininiiinology. 
I lie iininiinoloj'v jkuIidh (oiiMJcd (,| one Icctiiic and one lal)otalo(y period 
|)ci week. In llic hi, I tliicc \'(:ir. llic |)liiloso|)liv iiiidci lyiiij'_ tlic (oncc lot 
Hifdii ,il '.iiidi III', |);i', Ixcn imdcij'/)inj^ (tilifal ic examination. I lie jMiidin;^ 
j)rin( i|)le lias l>ee/i evolved that tlie material williiii our fu-ld sliould be |»rc- 
scMled lo medical students in sih Ii a way lo l)C' ol maximal use lo tliem as 
j)l)ysi( ians. I lie Iwo sei lions ol tlietoiirsc; have jiow Ixen (omhinefl .nid aie 
prcseuled in one semesler so as to give the sludeiil an ij)tegral(;d |>i( luic ol llie 
cliiiraclcrislH , ol tlie disease |)roduciiig microorganism, llie way it prorliKcs its 
eH'ects on tlie jiatienl, liow tlie l)0(|y i\c\i'.t\sc mc( lianisms o|)ei;ite ;iiid how the 
bala/Kc helweej) the invading organism and the |»atient (;in he alUtred. I'asic 
|)rinei|)|es are slron;'Jy em|)hasi/ed; tove/age ol the sid;je< 1 matter is laiily 
tom|>iehensive; lime devoted to dillercnl stihjcc'ts js r('aj)))ortioned in afiord 
ancc will) tin < miently rcrcogni/ed relative in)|)orlan(e r,( ihe dillercnl jaou|>s 
ol (iiscase |)iodii( iie' organisms. I he lahor.atory has heen d<-sigu(;d to illuslratc 
as many ol the iiii|)oi i:iiii |)heiioiiieii;i ;r, r, |na( ti( ;il. An entirely riew iahoratfjry 
iDanual has heen < oiii|)iled. Suhjei t matter, laboratory exercises and methods 
ol leaching aie undei (onlinuous reevalualion and eritieal reexamination. 

All lac ulty members ol the various professicjiial ranks parlic ijjatc- in the 
lee line seiies in accordance' with tliei/ intc-rests anci sj)ce iai kncjwiedge anci all 
lac ulty membc-rs j^artic i|>atc- in su|>ervisicM) c>| sludc-nls in the- labc^ralc^ry |n)rlicHi 
ol llur c cMirscs While the- coverall |)C)lie ies pc-rlaining tc> the labctratcjry are arrived 
at ihrcaigh lac nil v elisc iission, Dr. Anchew ( #. Smith has assume el ihe- fes|>onsi- 
bilily e;| administering the- student labc<ralc^ry wcjrk e;ji the detailed day lc> day 
basis and has cjrgaiii/ed a cc>inj)etenl lean) whic h c-xereises this lufic licMi in a 
very hue manner. 

b. ( )ther ( enices 

J he departiii'iii has ollered a limitecl series e,| '.jjee iali/eel c cuirscs designed 
primarily lor the- needs ai ciur graduate students. ()iu- oi the recent additiejiis 
to this series cij ccjurses is the cjue in medical niyce^lcigy given by Dr. Smith. 
Not f)nly has this jjaitic iilai course served tlie graduate students but it has also 
been attended by rcsidctits in dermatology tc) supplement thcrir basic training 
program and by labcjratcjry tec hnic ians Irctni varic)us parts cil the sche^c>|. A new 
ecHirsc- in b.ic Icii.il c vlc<lcjgv is also bein;'^ cdlered on a clemancl basis lor graduate; 
students. 

C. I'.xtra Dej)arlmenlal I csic hing 

This c|e-parl(nent has co opc*ralee| in every way possible with either dc.part- 
mcnis c,| the se licjol in an atten)j)i to integrate- basic science material with the 
clinical subjects. During the past year, \)r. Wisseman has held regular sessicjns 
with the junior students in clinical pathcjle^gy oii labc^ratcjry diagnosis <i\ febrile 



28 nUlLETlS or TllF SCHOOL OF MED/CINE, V. OF MD. 

illness aiul with )iinior stiulcnls in obstetrics and l;\ nccologN on basic and 
applied aspects ol microbiologx in this clinical specialtx. Dr. Wisseman also 
ga\e a series of lectures on inllaniniation and on the patholog\' of rickettsial 
diseases to the students of the sophomore course in pathology and several 
lectures in jiarasitologx in the clinical jiathologv course. Finallw Dr. Wisseman 
has participated in the teaching ot senior students in the Medical Out Patient 
Department during the seconti semester ol the current \ear one day each week 
insofar as his other duties would peiiiiit him. 

4. Research Program 

Considerable eHort has gone into dexeloping an actixe research program in 
this department. Progress in this area has gone hand in hand with the improve- 
ment in physical facilities and equipment. /\t the present time approximately 
$50,000 a year is being obtained from outside sources to support specific research 
projects. The major research actixities at the present are briefly reviewed below: 

a. Attenuated Living Vaccines for /Xrthropod-borne Virus Diseases. Dr. Wisseman 
and Dr. Sweet are collaborating on a project generously supported under 
contract from the Office of the Surgeon General, Department of the Army, and 
sponsored hv the Commission on Immunization of the Armed Forces Epi- 
demiological Board. This project emphasized particularly the development of 
practical vaccines for the protection of troops against dengue fevers. In its 
broader aspects this project also must deal with fundamental problems of 
immunity and cross-immunity to yellow fexer, Japanese encephalitis, Russian 
spring summer encephalitis and other arthropod-borne viral diseases. The sub- 
stantial financial support for this project has aided immeasurably the establish- 
ment of good facilities for virus research within the department. This project 
entails a wide variety of techniques and procedures and has necessitated de- 
velopment of facilities for tissue culture, neutralization tests in animals, safety 
testing in monkeys and field testing in volunteers. Dr. Sweet has contributed 
very significantly to the dexelopment of a sound research program on viral 
diseases. In connection with this project Dr. Wisseman carried out field studies 
in the Far East in 1956 where he worked in collaboration with army and 
cix'ilian medical authorities and scientists in Japan and in Malaya. It is 
anticipated that further overseas studies in endemic zones of interest will be a 
natural part of this project. The fine working relationship with the Commission 
on Immunization promises to xield continued support for studies in this 
important area and for contact with scientists on an international basis. 

b. Studies on host-parasite interactions are being carried out under Dr. Wisse- 
man's direction with particular emphasis on rickettsial infections of the typhus 
group and on infections with tularemia organisms. Here, basic research sup- 
ported by a grant from the United States Public Health Service is being 
carried out to explore rapid diagnostic techniques, the role of phagocytic cells 
in body defense mechanisms against rickettsial infections and factors influ- 
encing the intracellular growth of tularemia organisms; some basic biochemical 
studies are being carried out on typhus rickettsiae; and, in collaboration with 



DEPARTMENT OF MICROBIOLOGY 29 

Dr. Sheldon E. Greisman, physiologic studies on the mechanism of the action 
of rickettsial toxin in experimental animals are being pursued. This general 
area of rickettsial disease constitutes a second major research interest in this 
department. Work along these lines will continue and, indeed, application has 
been made for a grant from the Public I lealth Service to support a training 
program in this Held. 

c. In Dr. Andrew G. Smith's laborator\ research is being carried out along the 
following lines: cytologic observations on the germination of Clostridium 
perfringeiis spores; characterization of an antifungal antibiotic produced by a 
species of Bacillus; chemotherapeutic studies on Cryptocoecus infections; and 
techniques applicable to the cytologic study of bacteria. This work has been 
supported primarily by local and departmental sources as well as by funds 
from one of the drug companies. 

d. A small program on the screening of compounds for anti-viral acti\ ity is being 
instituted through arrangements with one of the drug houses in the hopes that 
some agent may be discovered which will be effective in the therapy of viral 
infections. 

e. Dr. Sheldon E. Greisman of the Department of Medicine has been carrying 
out an active research program within the Department of Microbiology. In 
addition to the physiologic studies of rickettsial toxins and endotoxins on the 
vascular s\'stem of experimental animals mentioned previously, he has con- 
tinued work in this department on a project initiated at the Hemorrhagic Fever 
Center in Korea in 1953 and 1954 dealing with injurious effects of human 
plasma on the peripheral vascular system of laboratory animals. It was in 
connection with this problem that Dr. Greisman and Dr. Wisseman became 
associated under field conditions in Korea and it was in anticipation of pursuing 
this project that Dr. Greisman originally joined the staff at the University of 
Maryland. Dr. Greisman has been carrying out an aggressive research program 
which puts to use his unique training in vascular physiology and his interests 
in immunology. Areas under investigation include anaphylaxis, A'ascular effects 
of hvperlipemic states and humoral factors injurious to the vascular system in 
traumatic and hemorrhagic shock. While most of the studies to date have 
been supported from local sources, Dr. Greisman has recently been awarded 
a research grant from the U. S. Public Health Service to support some of 
these investigations and he has another grant pending. His position here is 
unique; while he holds an appointment in the Department of Medicine, his 
research interest has transgressed departmental barriers, centering mainly in 
the Department of Microbiology but extending also into the Department of 
Surgery. It has been a pleasure and a privilege for the Department of Micro- 
biology to support him in his work and to collaborate with him on problems 
of mutual interest. 

f. During the past several months. Dr. Cirange S. Coffin of the Department of 
Pediatrics has been working in this department in ex]")loratory studies on 
bactericidal and bacteriostatic agents in the human placenta which may serve 



30 BULLETIN OF THE SCHOOL OF MEDICINE, LI. OF MD. 

as a barrier to the passing ol iiileetioiis agents lri)ni the nu)iher ti) the letus. 
We consider it a privilege to be able to pro\icle taeilities lor this kind ot work. 
The research program has pro\ided excellent opportunities lor medical students 
on summer fellowships and it is anticipated that it will pro\ide a basis lor a 
\erv strong graduate and post doctoral training program. 

5. Graduate Program 

This department oilers a graduate training program lor the degrees of Master 
of Science and Doctor t)f Phil()so[ih\ in Metlical i\licrobiolog\. During the past 
year considerable rcxision has been made in the graduate training curriculiuii 
based upon a redelined philosopln. It is lelt that persons graduating with an 
advanced degree frt)m this department should be competentlx' and broadU trainetl 
in nu'dical niicrobiolog\ and ancillaix areas. The graduate training program should 
pro\itle an adec|uate background lor the areas into which medical microbiologists 
commonh \enture, i.e., teaching, research, diagnostic and practical aspects of 
medical microbiologw and nidustrial, go\ernniciital and [uiblic health laboratories. 
Toward these ends a program is being developed which will make greater use 
of the courses available in other parts of the Llnixcrsitv structure, which will 
pro\ ide the candidate with the desirable and necessary teaching experience, which 
can provide opportunitv for gaining familiaritv with practical medical micro- 
biology and which provides ample opportimit)' for develo[)ment in original research 
lines. This program will be integrated very closely with the medical school's new ly 
formulated plan of a combined M.D.-Ph.D. degree for selected students. 

6. Service buiictions of tlje Depart})ient 

Since last Fall, Dr. VVisseman has assumed consultative and supervisorv re- 
sponsibilities in the diagnostic serology and bacteriology laboratories of the Uni- 
versity Hospital. It is anticipated that this new relationship will be mutually 
beneficial to the Department of Clinical Pathologv and the Department of Micro- 
biology and that these laboratories will be integrated eventually into the projected 
training programs for medical technologists, residents in clinical pathologv and 
graduate students in the Department of Microbiology. Dr. A. G. Smith has 
rendered advisory and consultative service in medical mycology to various sections 
of the institution from time to time. 

7. Facilities and Eciuipnieiit 

The facilities and equipment have long been grosslv inadequate for a modern 
teaching and research program in medical microbiologv. In the attempt to correct 
this situation, a long range developmental program has been instituted which 
undoubtedly will rccpiire a period of years to mature. An extensive remodeling 
program has been put into elfect and already has improved the teaching area, 
provided departmental offices, and freed space for research laboratories. Moreover, 
new laboratory space has been acquired, remodeled, furnished and ecjuippcd. This 
slow process must continue until all areas in the department are adecjuaiclv housed 
and equipped. A large part ol [\\c clc|iartmcntal operating funds has gone into 
purchase of ec|uipmcnt lor the student laboratorv and for essential general depart- 



DEPARTMENT OT MICIiOI'.IOI OC.Y 31 

iiK'iital cc|iiij)iiKiit. I lie iR'W rc'st'artli laboratories have been e(|iii|)))i d tliiou^^h 
research grants aiul eoiitraels. In aclclition to these strictly departmental ventures, 
this department has co sponsored siiecesslidly recpiests to liie Public I lealth Service 
lor lunds to buy certain items of exj)ensive ca])ital etjuipment lor interdej)artmental 
use, such as analytical and preparative ultracentriliiges and an electron microscope, 
riie im|iortance oF |)roviding adecjuate physical facilities and ec|uij)ment can- 
not be o\er empliasi/.ed. It is essential to both teaching and research |)rograms. 
Moreover, lailure to be able to exhibit reasonable laeilities has been a serious 
deterring laetor to accpiisition ol new laculty |)ersoiniel in the past. We believe 
that the laeilities are just now a|)proaching a minimally satislactorv state of 
development lor attracting the desirable kind ol lac ultv, lellow, and gradiiale 
student. iNevertheless, this costly ellort must be continued lor a time so that the 
teaching |)rogram can mature pro|)erly and the research ellort can progress and 
that good lacuIlN members remain content to sta\ at the Unix'crsitv nl Mar\land. 

8. Coviniiinity Service 

\Uc l)e|)artment ol Microbiology is now reprc-sented on several slate and 
jiational bodies. Dr. Wisseman serves as a member ol the Bacteriology Test Com- 
mittee of the National Hoard of Medical I Examiners, as a member of the Medical 
Advisory Committee of the Chemical Cor|)s Advisory Council for the U.S. Army, 
as associate member and responsible investigator of the Commission on Immuniza- 
tion of the Armed Forces li,j5idcmiological Hoard and as member and deputy 
director ol the C'ommission on I'ickettsial Diseases ol the Armed 1 orces L|)i- 
demiological Hoard, lie has recently bec-n appoinlcd lo the Advisory Committee 
on Influen/a to the Maryland State Department ol I lealth. Dr. Sweet serves as 
Princijxil Professional Assistant to the research |)rogram sjionsored by the Com- 
mission on Immunization. 

9. I cciurcs, (jjiifcrcnccs, I'cij/crs lU'cul, mid I'lihliccilioyis 
a. Lectures, (.lonferences, etc. 

(Ij Dr. Wisseman (Microbiology^ and Dr. McCrumb f Inlectious Diseases) 
conducted a |)ost-graduate teaching session on November 21, 19S6, on 
Infectious Diseases— Modern Diagnosis and Ireatmcnl for the Delaware 
Academy of Ceneral Practice in Wilmington, Delaware, under the 
auspices of our Postgraduate Committee. 

(2) Dr. Wisseman conducted a stalf conference on staphylococcal pneumonia 
at the Union Memorial 1 los|)ital in Baltimore on Feb. 6, 1957. 

(3) Dr. Wisseman gave a lecture entitled Problems in Rational Chemotherapy 
for the University of Maryland Postgraduate Course on Hasic Sciences 
as Fhev Aj^plv to the Prac ticc- of Medic ine, on March 20, I9S7. 

I). l'iii)eys I'u'iicl (It Meetings 

(1) Wisseman, C-. L., Jr.: Physiologic studies on the action of rickettsial toxins. 
Maryland Hranch, Society of American Hacteriologists, 1956. 

(2) Gauld, J. H.; Wisseman, C-. F., jr. and Swanson, R. C. : Phagocytosis and 
opsonization of t\ pluis rickettsiae. Mar\ land PManch, Society of /Xmerican 
Hacteriologists, April 6, 1957. 



32 BULLETIN OF THE SCHOOL OF MEDICINE, 11. OV MD. 

(3) Smith, A. Ci. and Heinz, E. C : Cytologic obscrxatioiis on llic germination 
oi Closiridiimi /'t'r/r;;/L;(.')/s spores. Marxlaml liiancli, Societ\' o( /Vmeriean 
Bacteriologists, April 6, 1957. 
c. PithJicatioiis: 

(1) Smith. Anchew G. and lillncr, Paul D.: Cvtologic obserxation on the 
sporulation process ol Clonty'tdiiiin j^crfri likens. J. Bact. 73: 1— (1957). 

(2) 1 lahn, F. \l.: 1 laves, j. E.; Wisseman, C. L.. Jr.; I lopps, 1 1. E. and Smadel. 
). E. : Mode of action ol C^hlorampiienicol \'l. lu'lalion hetween structme 
and actix'itv in the Chloramphenicol series. /Vntihiotics and C^hemother. 
6:531-543(195(0. 

(3) 1 lopps, 11. E.; I lahn. E. E.; Wisseman. C. L., jr.; Jackson, E. K and 
Smadel, J. E. : Metabolic studies ol rickettsiae. 111. Studies ol transamina 
tion o.\idati\'e phosphorx lation and glutamate -2-C' ' incorjioration b\ 
junilied suspensions ol }\ickcllsin iiiooscri. J. Bad. 71: 708 716 (1956). 

(4) 1 lopps, 11. E.; Wisseman, C. L., Jr.; 1 lahn. k. 1-.; Smadel, J. E. and 
Ho, R. : Mode of action ol Chloramphenicol IV. lailure of selected 
natural metabolites to re\crse antibiotic action. J. IkicI. 72: 561-567 
(1956). 

(5) Wisseman, C. L.. Jr.: Scnih I'yplnis. CU. 63. [ip. 464-469. /;/ Meakins, 
J. C. The Practice of Medicine 6th Ed.. C. V. Mosbey Co., 1956. 

10. Rcconniiciulcitioiis for 1 iiiju'ovciiicnt 

a. PhysJccil facilities. Many recommendations for imjirox'cment of physical facili- 
ties could be made most apjiropriateK. Most of these, however, could not be 
brought to Iriiition practicalK without a new basic science building card idly 
designed to meet the needs of an acti\elv growing department and it is earnestly 
hoped that serious consideration is being gi\en to the matter lor carK' construc- 
tion ol modern anti adec|iialc lacilities lor the basic sciences as a whole. 

Ol immediate concern is the need lor remodeling and etiiiii^ping existing 
laboratory space lor a metabolic imit. Three small, badU' designed and inade- 
cjuately lurnishetl laboratories locatetl within the departmental area on the 
second floor at the Patholog\' Building are destined to become the work area 
for a luiit de\'oted to the stucK of microbial metabolism. In order to be able 
to attract a competent person to fill the ojxmi lacidt\ position, it will be 
necessarx' to provide reasonable lacilities. Ehis laboratory constitutes the only 
area now a part of this department which has not been brought up to a 
minimally satisfactory standard. Plans are being drawn up for remodeling this 
section and will be submitted for consideration. 

b. Personnel. From a totally practical point of \ievv, the matter of adecpiate 
supporting personnel in the Preparation Boom is most urgent. 1 he increased 
demands which ha\e fallen on this section have been described abcAC in 
Section 2 under Stafl". Accordingh', recpiest has been made in the 1958-1959 
budget for the necessary additional support. 

Future faculty rec|uirements can best be estimated as the current program 
matures and will be presented as needs arise. 



DEPARTMENT OF PHARMACOLOGY 

1. Operating plan mid ideology 

The aim ol the course is to teach the principles which underhe the use of drugs 
in the treatment, cure, mitigation and diagnosis of disease. 

2. Faculty and Staff 

John Christian Krant/, Jr., Ph.D., Professor of Pharmacology and Head of the 

Department. 
Frederick K. Bell, Ph.D., Assistant in Pharmacology. 
Raymond Merritt Burgison, Ph.D., Associate Professor of Pharmacology. 
Ruth Musser, M.S., Instructor in Pharmacology. 
Edward B\ id Truitt, Jr., Ph.D., Associate Professor of Pharmacology. 

ADJUNCT FACULTY 

Joseph McCuric)' White, 111, M.D., Lecturer in Pharmacology. 
Stephen Krop, Ph.D., Lecturer in Pharmacology. 
From the Academ\' of General Practice: 

Louis V. Blum', M.D. 

Walter A. Anderson, M.D. 
Adalbert Schubart, M.D., Resident in Medicine. 
Harold H. Bryant, Ph.D. 

3. Teaching 

The instruction is designed to include those phases of pharmacology necessary 
for an intelligent use of drugs in the treatment of disease. The didactic instruction 
includes materia medica, pharmacy, prescription writing, toxicology, posology, phar- 
macodynamics, and experimental therapeutics. The laboratory exercises parallel the 
course of lectures. In addition, conference periods and discussion groups are gi\en 
vyeekly with the facult\' and adjunct faculty. 

From 10 to 15 \'isiting lecturers gi\e instruction to our class in the broader aspects 
of pharmacologN' and man\ current research projects. The teaching is integrated 
with the clinical departments of medicine, anesthesiology and obstetrics by inter- 
departmental lectures. 

4. Research 

a. Synthesis and pharmacologic study of theophylline deri\ati\'es in h\ pertension. 

b. Study of new fluorinated ethers as anesthetics. 

c. Study of new fluorinated ether (IndokKnO in the treatment of mentalK ill 
jiatients. 

d. Alcohol and acetaldelnde in cerebral metabolism. 

e. Salicylate absorption. 

f. Aliphatic iodides in torulosis (with microbiology). 

g. Alkali metal ions and red cell hemolysis. 

h. Myristicin euphoria and toxicity (with ps\ehiatry). 
i. Toxicity of organic boron deri\ati\'es. 

33 



34 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

5. Graduate program 

Four students working for Ph.D. degree. 

Participation in graduate instruction in basic science for Postgraduate Committee. 
Graduate course in pharmacologic methods: 62 hours given to graduate students 
on Bahimore campus by Dr. Truitt. 

6. Statistical Aiialysis. No comment. 

7. Facilities and equipment 

Third floor of Dressier Building with adequate equipment for teaching and 
research in pharmacology and cognate sciences. 

8. Couivinnity service 

Revision of formularv for medicallv indigent, for Baltimore City Health Depart- 
ment. 
Service on U.S. P. Revision Committee. 
Service in National Research Council data compilations. 
Advisorv Committee on Medical Care. 
Numerous public lectures. 
RcA'ision of textbook in pharmacology. 

9. Ptd^Ucations 

WoLPERT, A.; Truitt, E. B., Jr.; Bell, F. K. and Krantz, J. C, Jr.: Anesthesia L. The 
effect of certain narcotics on oxidative phosphorylation. J. Pharmacol. Exper. Therap., 117: 358, 
1956. 

Krantz, J. C, Jr.: Editorial. Admission to your medical school. Bull. Sch. of Med., Univ. of 
Md., 41: 73, 1956. 

Krantz, J. C, Jr.: The sulfonamides after two decades. International Record of Medicine, 
169: 553, 1956. 

O'Malley, W. E.; Truitt, E. B., Jr.: Hulme, N. A. and Krantz, J. C, Jr.: Anesthesia 
LII. Pharmacologic study of certain ethinyl barbiturates. Anesthesiology, 17: 585, 1956. 

Krantz, J. C, Jr.: The use of drugs in bronchial asthma. Current Medical Digest, 23: 63, 
1956. 

WmTE, J. M.; Heisse, C. K. and Krantz, J. C, Jr.: Anesthesia XLIX. Hypnosis with analgesic 
combinations. Current Researches in Anesthesia and Analgesia, 35: 526, 1956. 

Truitt, E. B., Jr.; Bell, F. K. and Krantz, J. C, Jr.: Anesthesia LIII. Effects of alcohols 
and acetaldehyde on oxidative phosphorylation in brain. Quarterly Journal of Studies on Alcohol, 
17: 594, 1956. 

BuRGisoN, R. M.; O'Malley, W. E.; Heisse, C. K. and Krantz, J. C, Jr.: Pharmacologic 
studies with 8-(para-aminobenzyl)-caffeine and certain related compounds. J. Pharmacol. Exper. 
Therap., 119: 107, 1957. 

Krantz, J. C, Jr.: Present status of psychopharmacology. Modern Medicine, January 15, 
1957, p. 75. 

Truitt, E. B., Jr.: Pharmacology of the Ataractic Drugs. Modern Medicine, January 15, 1957, 
p. 77. 



DEPARTMENT OF PHYSIOLOGY 

1. General Stateuient 

The dcjxutmcnt is organized (1) to teach physiology to freshmen medical 
students, i^-^ to instruct giatkiate students, and (3) to conduct investigation. 

2. Facility n\hl Stajf 

Wilham R. /Xmheison. Ph.D., Professor ol Physiology and Head of the Depart- 
ment. 
Dietrich C. Smith, Ph.D., Professor of Physiology. 
Frederick P. Ferguson, Ph.D., Professor of Physiology. 
John I. White, Ph.D., Assistant Professor of Physiology. 
Samuel L. Fox, M.D., Assistant Professor of Physiology. 
Svhia riimmelfarh, A.B., Instructor in Phvsiologv. 
Jeanne A. Barr) , B.A., Junior Instructor in Phvsiologv. 
Armand 1. Gold. Ph.D., Assistant Professor of Plnsiological Research. 
J. I Icnrv Wills. Ph.D., Lecturer in Plnsiologv. 

3. Teaching 

The basic course in physiology is gi\"en to Hrst year medical students in the 
second semester. The coinse inchidcs 7S lectures, 15 conferences and 120 labora- 
tory hoins htr each stutlcnt. Lectures arc prepared by stalf members mainU Irom 
the original literatures, rather than Ironi text books. A free atmosphere is main- 
tained in Icctme and laborator\ , with stutlent cjuestion and suggestion inxiled, 
optional work is permitted, and a critical altitude enct)iiraged. Mammalian opera- 
ti\'e work is emphasi/ed. /\ portion ol the laboratory set|uence consists ol demon- 
strations, including ophthalmoscopy, electrocardiography, the electroencephalo- 
gram, radiologN . radioisotopes, the oscilloscope, electrophoresis and the ultra- 
centrifuge. 

Dr. .\mberson has participated in the teaching program of the Department of 
Obstetrics and Gynecology. 

4. Research 

(1) Dr. Smith and Dr. Ferguson, with the collaboration of Dr. Gold, Mrs. Barry 
and Miss Elaine Siher, ha\e continued their research on the effect of acute 
decompression stress upon water and electrolyte distribution and renal func- 
tion. At the present time particular attention is directed toward the study of 
physiological mechanisms which operate to decrease the concentration of 
plasma potassium in dogs dining moderate decompression produced by ex- 
posure to a simulated altitude of 30,000 feet for 30 to 90 minutes. This pro- 
gram is currently being supported by a grant from the LI. S. Public Health 
Service. Members of this research group ha\e ]iresented two papers at meet- 
ings of national scientific organizations during the cmrent fiscal year. Mrs. 
Barr\- delixercd a jiapcr before the April meeting of the .American Phvsio- 

35 



36 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

logical St)ciet\ in Chicago, Illinois. In May, Dr. Ferguson spoke at the 
meeting of the Aero Medical Association in Denx'er, Colorado. 

(2) Dr. John I. White and Miss Sylvia Himmclfarb have continued research in 
the muscle protein held, extending the observations reported in the last three 
papers oF the publication list given belou'. This work is supported by a grant 
From the LI. S. Public Health Service. The new Fibrous A protein, extracted 
From skeletal muscle, has now been crvstallized. Two his;hlv bireFrinoent 
crystalline Forms have been observed. Solutions made From this crystallized 
material show a considerablv higher viscosity than do the original cruder 
extracts. Complex Formation with myosin has been demonstrated, both in 
electrophoresis and in the s\nthctic boundarv cell in the ultraccntrifuge. 
A protein resembles nucleotropom\'osin in crvstal structure, but is sharplv 
distinguished From the latter molecule by the absence oF nucleic acid. 

(3) Under Dr. Amberson's direction, Mr. Richard L. Classer completed his 
doctoral thesis, devoted to a study oF a reflex center in the lower pons whose 
hvperacti\'ity, after midpontile transection and double vagotomy, causes an 
enduring increase in blood pressure and heart rate. These results were pre- 
sented before the spring meeting of the American Physiological Society, held 
in Chicago in April. Mr. Glasser received the Ph.D. degree from this Uni- 
versity in June. He has now joined the staff of the Department of Physiology, 
School of Medicine, University of North Carolina. 

5. Gr adulate Progrmu 

Graduate students take the basic course with the medical students. They meet 
with a member of the staFf each week for further discussion of major topics. Other 
graduate courses are available, as shown in the catalogue. 

A special situation in respect to graduate instruction has developed during the 
year. For the last eight years a graduate program in physiology, biochemistry and 
pharmacology has operated at the Army Chemical Center under the auspices of 
the University of Maryland. The University and the Army have been bound by 
contract in giving this work. The Army failed to renew the contract in the summer 
of 1956, and courses scheduled for 1956-1957 could not be given as planned. At 
the beginning of the second semester this Department decided to reopen graduate 
instruction in physiology at the Center, without benefit of contract. This emer- 
gency program has been approved by the University authorities, and permitted 
by the Army command. A weekly seminar has been given through the second 
semester. An attempt is being made to qualify a small group of graduate students 
for the master's and doctor's degree. Staff services are being rendered without 
compensation. Course fees are paid to the School of Medicine. 

6. Statistical Aualysis— Not applicable. 

7. Facilities and eqiiipiueiit 

As the result of a special grant from the U. S. Public Health Ser\'ice the 
Department has purchased a Spinco analvtical centrifuge, with all accessories. A 
|)re|xirati\e ultraccntrifuge has also been acquired from the same grant. Room 420 



DEPARTMENT OF PHYSIOLOGY 37 

has become an ultraccntrifuge room, used mainly by the research group which is 
studying the new fibrous muscle protein, but open to other departments which 
wish to use the equipment. This room operates under the direction of Dr. White. 

8. Community Serr/ce— Nothing to report. 

9. Piihlicatious diiviwj^ the Fiscal Year, July i, 1956-Juue 30, 1957. 

Ferguson, F. P.; Smith, D. C. and Barry, J. Q.: The response of plasma potassium to acute 
decompression stress in adrenalectomized dogs. Air LIni\'ersitv, School of Aviation Medicine, 
USAF, Report No. 57-14, pp. 1-12, Nov., 1956. 

Barry, J. Q.; Ferguson, F. P. and Smith, D. C: Effect of moderate and severe decompression 
on blood glucose of adrenalectomized dogs. Federation Proc. 16, 8, 1957. 

Ferguson, F. P.: Potassium changes in dogs during acute decompression stress. J. Aviation 
IMed. 28, 199, 1957. 

Ferguson, F. P.; Smith, D. C. and Barry, J. O.: fivpokalemia in adrenalectomized dogs 
during acute decompression stress. Endocrinology 60, 761-767, 1957 

Glasser, R. L. : Lower brain stem facilitation of cardiovascular activity. Federation Proc. 16, 
47, 1957. 

Amberson, W. R.; White, J. I.; Bensusan, H. B.; Himmelfarb, S. and Blankenhorn, 
B. E. : A Protein, A new fibrous protein of skeletal muscle: Preparation. Am. J. Physiol. 188, 
205-211, 1957. 

White, J. I.; Bensusan, H. B.; Himmelfarb, S.; Blankenhorn, B. E. and Amberson, 
W. R. : A Protein, A new fibrous protein of skeletal muscle: Properties. Am. J. Phvsiol. 188, 
212-218, 1957. 

Bensusan, H. B.; White, J. I.; Himmelfarb, S.; Blankenhorn, B. E. and Amberson, 
W. R.: A Protein, A new fibrous protein of skeletal muscle: Complex formation with myosin. 
Am. J. Physiol. 188, 219-226, 1957. 

10. Recommendatiojis for Improvement 

The Department should ha\"e additional space. A number of small rooms are 
needed for special techniques taught in the basic medical physiology course. If 
more graduate students are to be enrolled, one or two more rooms should be 
available. 

The Surxev Team which examined the School of Medicine in November, 
1955, recommended the creation of a new instructorship in this Department, to 
be filled by a young Ph.D. skilled in electronic methods. Proposals for the creation 
of this recommended post have not been accepted by the administration. The 
departure of Dr. Glasser renders this need even more imperati\'e. 



CLINICAL DEPARTMENTS 
DEPARTMENT OF ANESTHESIOLOGY 

DEPARTMENTAL PERSONNEL 

Physician Staff: 
Attending: 

Martin Helrich, M.D., Professor of Anesthesiology and Anesthesiologist-in-Chief 

Paul R. Hackett, M.D., Anesthesiologist and Assistant Chief 

Howard S. Liang, M.D., Associate Anesthesiologist 

Dorothy C. Holzworth, M.D., Associate Anesthesiologist 

Thomas D. Graff, M.D., Anesthesiologist 

Douglas H. Smith, M.D., Anesthesiologist 

John R. Marshall, M.D., Anesthesiologist 

Residents: 

Edward J. Sheffman, M.D., Resident 
Edward S. Klohr, Jr., M.D., Resident 
Lucila P. Lesser, M.D., Resident 
Elizabeth Dorringer, M.D., Resident 
Heinrich Loseman, M.D., Assistant Resident 
Ronald Mendelsohn, M.D., Assistant Resident 
Frederick Tesher, D.D.S., Assistant Resident 

Nurses: 

Mary J. O'Brien, R.N., Nurse Anesthetist, Supervisor 
Elizabeth Maszarose, R.N., Nurse Anesthetist 
Corinne Moore, R.N., Nurse Anesthetist 
Cynthia McNerney, R.N., Nurse Anesthetist 

In addition to the above named personnel, interns on a one month basis, surgical 
assistant residents on a two month basis, and dental interns on a three month basis 
rotated through this service. 

Dr. Martin Helrich joined the Department of Anesthesiology in October of 1956 
as Professor and Chairman to fill the vacancy left by the resignation of Dr. Robert 
Dodd. The interim period from Dr. Dodd's resignation in February of 1956 until Dr. 
Helrich's arrival was ably managed by the Associate Professor, Dr. Paul Hackett. 
Dr. Howard S. Liang and Dr. Dorothy C. Holzworth were both promoted from 
assistant to associate anesthesiologists. Dr. Douglas H. Smith became the first graduate 
of our residency program in Anesthesiology to join the staff of the department. Dr. 
Smith resigned after completing one year in this capacity to the armed forces. Dr. 
Thomas D. Graff joined the department as instructor in Anesthesiology for a period 
of six months during the past year. He has since left to practice at another hospital in 
the Baltimore area but continues to take an active part in research and teachino' 
activities. This past year saw the expansion of the residency program to include three 

39 



40 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

residents and three assistant residents. The teaching program has been markedly 
expanded to include anesthesia for thoracic surgery at the Mount Wilson State 
1 lospital, anesthesia for pediatric-orthopedic patients at the Kcrnan Hospital for 
Crippled Children, and a one month affiliation for each of the residents at the 
Children's Hospital of Philadelphia. These affiliations have been inxaluable in expand- 
ing the \ariet\' and scope of material offered to our residents during their training 
program. 

Depart iiiciiial Activities 

The following medical meetings were attended b\' members of the department 
during the past vear: the meeting of the American Society of Anesthesiologists at 
Kansas Citv, the Post-graduate Assembly in Anesthesiology at New York City at which 
time a paper on the "Circulatory Effects of Preoperative Medication " was presented b\ 
Dr. Helrich, a s\mposium of under water and high altitude phvsiolog\' under the 
auspices of the Medical Education for National Defense (MEND) and the meeting 
of the .Association of University Anesthetists which was held in Philadelphia. 

Se\eral talks were presented by \'arious members of the department. Dr. Helrich 
conducted a round table discussion on the "Use of Tranquilizers in Anesthesiolog\" 
at the annual meeting of the Maryland State Medical Society. Dr. Hackett presented 
a discussion on the "Use of Hypothermia in Cardiac Surgery" on the closed circuit 
telex'ision program for Alumni Day. Dr. Helrich discussed the "Untoward Effects of 
Tranquilizers' at the County Medical Society meeting in Salisbury. Dr. Helrich 
presented a paper on the "Circulatory Effects of Spinal Anesthesia " at the Columbia 
Presbyterian Medical Center in New York. Drs. Hackett and Helrich addressed 
the newly formed Maryland Dental Society of Anesthetists. The Department of 
Pharmacolog^' and the \'arious classes in the Dental School were addressed by \'arious 
members of the department. A half hour TV program on the "Management of 
Anesthesia for Tonsillectomy" was presented as part of the Uni\'ersity-WBAL TV-MD 
series. 

Sexeral distinguished guest lecturers were sponsored b\ the Department of 
Anesthesiology during the past ^'ear. A Symposium on Ner^'e Block and a Nerve 
Block Clinic was presented by Dr. E. A. Rovenstinc, Professor of Anesthesiology at 
the N. Y. U. Bellevue Medical Center in. New York; Dr. E. H. Connor, Chief of' the 
Department of Anesthesiology at Philadelphia General Hospital presented a lecture 
on the "Study of the Circulation". The Saturday mornina combined seminar was 
addressed by Dr. Robert D. Dripps, Professor of Anesthesiology at the University of 
Pennsylvania who discussed the "Management of Mass Casualties". Dr. Henry L. 
Price, Associate Research Professor of Anesthesiology at the University of Penns\'lvania 
lectured on the "Relationship of Epinephrine and Norepinephrine to Anesthesiology"'. 
Dr. Donald H. Stubbs of Washington, D. C. presented a fascinating discussion of 
the "Anesthesiologist as a Physician". Dr. James O. Elam of the Army Chemical Center 
and the Department of Anesthesiology at Roswell Park Institute in Buffalo offered 
a new concept in the management of carbon dioxide absorption. In addition to these 
visitors, several distinguished speakers from the Baltimore area were heard b\' the 
local group. 



DEPARTMENT OF ANESTHESIOLOGY 41 



Research 



Although there were no indi\'idual efforts on the part of the Department of 
Anesthesiology in the in\estigated field during the past year, se\eral members of the 
deixutment were aeti\el\ enoaoed in researeh aeti\ities in affiliation with researeh 
teams from other departments. The studN' of a pump oxygenator for eardiae bypass 
during intracardiae surgery was in\estigated b\ Dr. llaekett with the thoracie surgery 
team, in eonjimction with the Department of Electroencephalograph\- studies on the 
eft'eets on the cortex of high spinal anesthesia ha\e been initiated b\ Dr. 1 lehich. In 
affiliation with this same department and the neurosurger\ group, an effort is being 
made by Dr. I lackett to determine the electro-encephalographic effect of h\ pothermia 
and ligation of the cerebral circulation during operation for cerebral aneurxsm. Dr. 
Klohr worked with the Department of Pharmacolog\ and the Department of Psychiatry 
on the inyestigation of the use of a fiuorinated ether to produce shock therapy. 

The chemistry laboratory of the Department of Anesthesiology has been completed 
and is situated on the se\'enth floor of the Psychiatric Institute. It is a completely 
equipped laboratory and will be capable of handling the analysis of all \arieties of 
samples pertaining to anesthetic agents as well as other body chemical changes. In 
addition, space has been allotted by the Department of Surgery in their dog laboratory 
in the Bressler Building. At the present time, Dr. Graff is actixely engaged in studying 
the effect of \'arving concentration of carbon dioxide on the incidence and type of 
cyclopropane— epinephrine arrh\'thmias in the dog. 

Eqiiiyiiioit 

Considerable new equipment has been obtained during the past year. A physiologic 
monitoring unit has been constructed for use in the operating room. It will make 
possible the measurement of arterial blood pressiur, end expiratory carbon dioxide, the 
electrocardiogram, and the electroencephalogram w ith simultaneous recording of these 
four parameters. In addition, a cardioscope for use on the cardiac-surger\ patients has 
been made a\ailable to us by die Cardiology Department. A "Thermo-rite" blanket type 
heating and cooling unit has been secured to supplement our use of the tub ayailable 
for the treatment ol aj")neic jiatients. In addition, there is an Emerson X'entilation Meter 
for measuring tidal volume in anesthetized patients. The arriyal of two new anesthesia 
gas machines has made possible the release of some equipment for use in the obstetric 
deli\'ery rooms. The department is most grateful for the generous su|iport of the 
Women's Board who made possible the purchase of much of this equipment. 

Lihrarr 

Through the efforts of Dr. Stone, the anesthesia librarx has been enlarged to include 
most ayailable standard texts in anesthesiology as well as subscriptions to six excellent 
journals on anesthesiology. These are readily ayailable for use by the staff and residents. 
This ready ayailability of current literature has resulted in much more fruitful 
utilization of spare time b\ many of the staff. 

A file of teaching slides has been started and now numbers approximateh" 300 slides 
which are available to all of the staff' for their lectures and other tcachine activities. The 



42 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF AID. 

residency training program, as has been mentioned above, has had an excellent supply 
of teaching material at the Unixersity Hospital supplemented by the opportunities 
available at Alt. Wilson, Kernan, and the Children's Hospital of Philadelphia. A recent 
inspection bv the AMA resulted in approval with very favorable comments from the 
AMA representative. It is expected that a further inspection will be made by the 
American Board of Anesthesiology in the fall. It is hoped that we will be able to increase 
the residencv program to three years in the near future. Although this has not as yet 
been required by the American Board of Anesthesiology it is suspected by manv that 
it will be a requirement in the not too distant future. It is hoped that the third year 
would be spent by the resident in full time research activity under the guidance of one 
of the research staff. With our present laboratory facilities, this transition should be 
made without difficultv. 

Undergraduate Education 

In addition to the lectures given to the junior and senior class, each member of the 
senior class has spent a period of one week in the operating room. An effort has been 
made to permit the students to do more in the way of actual administration of anesthesia 
under the close supervision of a member of the staff. It is hoped that in the following 
year with the allotment of more time for this activity by the curriculum committee, 
a more complete program utilizing the facilities at the affiliated hospitals mav be 
implemented. 



DEPARTMENT OF MEDICINE 



A. Personnel 

Faculty members of the 
divisions are recorded in this 

Theodore E. Woodward 



Howard M. Hubert 
T. Nelson Carey 
Douglass G. Carrol 
Francis P. Chinard 
Thomas B. Connor 
Edward F. Cotter 

Ernest Cross, Jr. 
John S. Eastland 
Bennett L. Elisberg 
Patricia A. Elisberg 
William L. Fearing 
Maurice Feldman, Jr. 
Wetherbee Fort 
Irving Freeman 
Frank J. Geraghty 
Marvin Goldstein 
William H. Grenzer 
Samuel J. Hankin 
W. Grafton Hersperger 
Henry W. J. Holljes 
Meyer W. Jacobson 
Edward S. Kallins 
William H. Kammer, Jr. 
Arthur Karfgin 
James R. Karns 

Frank T. Kasik, Jr. 
Irvin B. Kemick 
Joseph D. King 
David M. Kipnis 
Crawford N. Kirkpatrick 
Louis A. M. Krause 
Harrv V. Langeluttig 
Franklin E. Leslie 
Manuel Levin 



Department of Medicine not listed in sub-specialty 
section. 

Professor of Medicine and Head of the 

Department 
Associate Professor of Medicine 
Professor of Clinical Medicine 
Assistant Professor of Medicine 
Assistant Professor of Medicine 
Assistant Professor of Medicine 
Associate Professor of Medicine 
Associate in Neurology 
Instructor in Medicine 
Associate Professor of Medicine 
Instructor in Experimental Medicine 
Assistant Instructor in Experimental Medicine 
Associate in Neurology 
Instructor in Medicine 
Assistant Professor of Medicine 
Associate in Medicine 
Assistant Professor of Medicine 
Instructor in Medicine 
Assistant in Medicine 
Instructor in Medicine 
Associate in Medicine 
Associate in Medicine 
Assistant Professor of Medicine 
Instructor in Medicine 
Instructor in Medicine 
Associate in Medicine 
Assistant Professor of Medicine and Head; 

Student Health Service 
Assistant in Medicine 
Instructor in Medicine 
Instructor in Medicine 
Associate in Medicine 
Jr. Instructor in Medicine 

Professor of Clinical Medicine 
Associate Professor of Medicine 
Instructor in Medicine 
Instructor in Medicine 



43 



44 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 



Ephraim T. Lisansky 
Leonard Lister 
S. J. Liu 
Robert J. Lyden 
Barbara A. Lyons 
John MacGibbon 
Stephen L. Magness 
James T. Marsh 
Joseph C. Matchar 
George McLean 
Ross McLean 
George S. Mirick 
S. Edwin Muller 
Joseph C. Myers 
John C. Osborne 
H. Raymond Peters 
Maurice C. PincofiFs 
J. Emmett Queen 
M. Kevin Quinn 
Juhan Reed 
Donald J. Roop 
Benjamin Rothfeld 
Herman Schaerf 
Adalbert Schubart 
Harry B. Scott 
Samuel Segall 
Lawrence M. Serra 
Charles E. Shaw 
Jerome Sherman 
Margaret L. Sherrard 
Solomon Smith 
William H. Smith 
William C. Speed, III 
William S. Spicer 
Patrick B. Storey 
Stuart D. Sunday 
Frederick J. Vollmer 
Julius Waghelstein 
Jack Wexler 
Philip Whitdesey 
John G. Wiswell 
Thomas L. Worsley, Jr. 



Associate Professor of Medicine 

Instructor in Medicine 

Instructor in Medicine (leave of absence) 

Assistant in Medicine 

Junior Instructor in Medicine 

Assistant in Medicine 

Assistant in Medicine 

Lecturer in Medicine 

Instructor in Medicine 

Assistant Professor of Medicine 

Assistant Professor of Medicine 

Assistant Professor of Medicine 

Assistant Professor of Medicine 

Assistant in Medicine 

Instructor in Medicine 

Professor of Clinical Medicine 

Professor of Medicine 

Associate in Medicine 

Assistant in Medicine 

Instructor in Medicine 

Assistant in Medicine 

Assistant in Medicine 

Assistant in Medicine 

Assistant in Medicine 

Instructor in Medicine 

Assistant in Medicine 

Assistant Professor of Medicine 

Associate in Medicine 

Associate in Medicine 

Assistant in Medicine 

Assistant Professor of Medicine 

Associate Professor of Clinical Medicine 

Instructor in Medicine 

Assistant in Medicine 

Assistant Professor of Medicine 

Instructor in Medicine 

Instructor in Medicine 

Instructor in Medicine 

Assistant in Medicine 

Instructor in Medicine 

Assistant in Medicine 

Assistant in Medicine 



DEPARTMENT OF MEDICINE 45 

B. Grauts-hi-Aid-1955-l957 

There are no specific grants-in-aid awarded to the department as such. The research 
and educational funds available to the department are shown in the respective sub- 
divisions. 

C. Ciinicidar Activities 

The sophomore course in phxsical diagnosis was improved during 1956-1957. 
Smaller tutorial groups permitted a few students and an instructor to emphasize the 
phvsical findings in normal subjects and in patients. The technique of history taking 
and case presentation at the bedside was stressed. Se\'eral stethotrons were provided by 
the Di\'ision of Cardiologv which permitted demonstration of single lesions to four or 
fi\e students simultaneouslv. Various audio-visual methods enabled the instructor to 
present cardiac abnormalities to the entire class. 

Sixteen lectures on general medical subjects are presented to the junior class. The 
bulk of the junior teaching in medicine is a clinical clerkship with the student spending 
nine weeks on the medical wards working with an intern, resident and attending 
physician. Bedside instruction is emphasized and the student is encouraged to present 
case material and to use the laboratory as an aid to diagnosis. The Loch Raven Veterans 
Administration Hospital is utilized for the instruction in diseases of the chest with 
approximatelv one-third of the class spending three weeks for instruction in tuberculosis, 
emphvsema, bronchiectasis and other disorders. A weekly conference conducted by 
members of the Departments of Pathologv and Medicine emphasizes the pathologic 
and phvsiologic alterations of neurologic and general medical disorders. 

The senior student spends approximately eight weeks in Medicine with four weeks 
as a clinical clerk on the wards of the Universitv Hospital, Mercy Hospital and the 
Fort Howard Veterans Administration Hospital. Four additional weeks are spent in 
the Medical Out-patient Clinic where patients are observed and studied with appro- 
priate supervision. In this clinic, a Home Care Program is conducted under the 
leadership of the General Practice Resident in Medicine and Head of the Medical 
Out-patient Clinic. The student attends patients with acute and chronic illnesses in 
the home. The student has the opportunitv to experience home practice and to observe 
the social aspects of medicine. This aspect of instruction is correlated with the program 
of the Department of Preventive Medicine and Rehabilitation. The student phvsician 
attends the various sub-specialty clinics of medicine. 

Summer fellowships ha\'e been encouraged for se\'eral years and during these 
months the student may work on the medical wards and participate in laboratory 
investigation. Student research has been encouraged. 

D. Research and Service Activities 

Research programs of the department have been described in the respecti\'e sub- 
di\'isions. A brief summary of completed studies or work in progress will be presented 
in this section of the annual report. 

A laboratory for investigation of the rheumatic diseases has been established in 
proximity to the arthritis clinic. This laboratory performs tests found useful for diagnosis 



46 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF AID. 

of the rheumatic group of diseases including the newer flocculation tests. The Arthritic 
Program is coordinated with the ward service of the University Hospital and the chronic 
disease hospital. The Arthritic Clinic participates in the instructional program of the 
Maryland Arthritis Foundation. 

Radioactive iodinated serum albumin has been utilized to assay blood volume in 
patients with congestive heart failure of various types. Preliminary results re\'eal that 
the blood volume is increased. The Division of Cardiology has undertaken studies to 
determine levels of quinidine in patients. A simple test has been developed which 
permits reproducible results and pro\'ides reliable data for following patients who 
receive this cardiac drug. 

The Infectious Disease Laboratory has been designated as a diagnostic center for 
the current influenza program. It provides diagnostic and research facilities for the 
Baltimore and Maryland area. Studies have been performed with the Asian flu vaccine 
dealing with the severity of reactions and antibody response to the vaccine. The side 
reactions to the Asian flu vaccine are of low order. Final evaluation of the vaccines 
efficacy is under study as a part of a nationwide program. The Department of Medicine 
as such is working in an advisory capacity with the Maryland State Health Department 
in connection with the State Control Program of Influenza. Diagnostic facilities for the 
identification of viral, rickettsial, and special bacterial agents are provided for the 
hospital and Maryland area. Tissue culture techniques are receiving major emphasis. 

Cytologic methods have been utilized for the diagnosis of malignant diseases of 
the upper and lower gastrointestinal tract. The Division of Gastro-enterology instituted 
the studies in 1954 as a part of a research program to appraise these methods for 
diagnosis of lesions of the lower gastro-intestinal tract. The technique has been very 
useful for confirmation of obvious colonic lesions and for detection of malignant lesions 
not otherwise apparent. The method, now standardized has been incorporated in the 
cytologic laboratory of the Department of Pathology. 

Studies have been undertaken to clarify the etiologv and pathogenesis of pvelo- 
nephritis with consideration given to a possible viral cause. Plans are underway to 
provide the hospital with dialysis apparatus for an artificial kidney and for a small 
biochemical laboratorv. This activity is in collaboration with the Departments of 
Surgery and Pediatrics. Methods have been perfected for the detection of serotonin 
(5-hydroxytryptamine) in tissue fluids. A precursor of this metabolite has been shown 
to improve the electroencephalogram in patients with hepatic coma. 

A ward has been established on the medical floor for concentration of patients with 
neurologic disorders. This ward permits correlative teaching of general medicine and 
neurology. Students and residents have been assigned to this ward which emphasizes 
general medicine and neurology. Investigations conducted by the Division of Neurology 
have revealed that transaminase is increased in the cerebrospinal fluid of patients with 
intracranial \'ascular lesions. A clinic for patients with multiple sclerosis was established 
in 1955. The census of this clinic is increasing graduallv. Patients are admitted regularlv 
to the medical ward for diagnostic work-up. A studv designed to clarify the dvnamics 
of the circulation of the spinal cord is in progress. Techniques have been perfected in 
animals and human application is contemplated. Present studies on bloody cerebro- 



DEPARTMENT OF MEDICINE 47 

spinal fluid have defined the absorption curves of bile pigment spectrophotometrically. 
Studies have failed to reveal the origin of bile pigment in the spinal fluid. 

The Division of Radioisotopes has acquired equipment for scanning the thyroid 
gland and for appraising size and location of glandular tissue. Isotopes have been 
used routinely for diagnostic, therapeutic, and investigative purposes utilizing radio- 
active 1-131, gold and sodium chromate. Clinical studies performed in collaboration 
with the Departments of Pediatrics and Neurosurgery show that radioisotopes are 
useful for localization of sub-dural collections of fluid in pediatric patients recovering 
from pyogenic meningitis. Radioactive gold has been shown to be of value in ameliorat- 
ing the clinical course of patients with malignant effusions. 

The hematologic section has conducted an active educational and investigative 
program. It has been reported that vitamin B-12 levels are elevated in patients with 
myeloid leukemia, the test finding some use in differential diagnosis. The problem of 
genetic relationships and abnormal hemaglobin formation is the subject of continued 
study. Much emphasis is being placed upon the inter-relationships of antigenic struc- 
ture, globulins, abnormal proteins, and blood cell function. 

A newly organized division of metabolism has emphasized thorough clinical work- 
up of patients with endocrinologic disorders. Studies related to calcium metabolism 
have been instituted as a part of a long term project. 

A division for the teaching and study of pulmonarv disease and respiratory function 
has been organized. Some effort will be directed toward clarifving the problems of 
mechanisms of resistance of the tubercule bacillus to the available anti-microbial agents. 
The problem of hypersensitivity and the host response to tuberculosis will be explored. 

Phvsiologic studies on the function of the lesser circulation ha\'e been conducted 
by Dr. Greisman working in collaboration with Dr. Wisseman, Head of the Depart- 
ment of Microbiology. 

A laboratory for identification of mvcotic agents has been established as a part of 
the Dermatology Clinic. This facility has enhanced the diagnosis of disorders of the 
skin caused by fungi and a study revealed that caudida albicans is increased above 
normal in the intestinal tract of patients who receive antibiotics. Clinical studies have 
demonstrated that antimicrobial drugs and steroids are effective in skin diseases of 
varied etiology. The importance of understanding the skin manifestations of systemic 
diseases as an aid to proper diagnosis has been emphasized. 

Residents in medicine have been active in clinical and laboratory research, working 
within various divisions of the department. Salmonella infections of the central nervous 
system have been the subject of one report with stress laid upon the need for operative 
removal of infected foci as a supplemental aid to antibiotic treatment. Other studies by 
house officers have been concerned with conduction abnormalities in patients with 
cardiac disease. Problems of carbohvdrate metabolism, mechanism of action of insulin 
and galactose tolerance studies have been undertaken in collaboration with the Di\ision 
of Biochemistrv of the Department of Pediatrics. 



48 BULLETIN OF THE SCHOOL OF MEDICINE, 17. OF AID. 

PUBLICATIONS 

Other bibliography shown in reports of respective sub-divisions of department. Piihlications— 
July 1, 1955-June 30', 1957. 

Woodward, T. E.: Clues to better understanding of the nature and treatment of certain infectious 

diseases, Am. J. Med. Sci., 231: 369, 1956. 
McCrumb, F. R., Jr.; Stockard, Joe L. and Woodward, T. E.: Leptospirosis as a major cause 

of short term pyrexia in a tropical environment. Trans. Assoc. Am. Phys., 69: 122, 1956. 
McCrumb, F. R., Jr.; Snyder, M. J. and Woodward, T. E.: Studies on human infection with 

Pastenrella titlarensis. I. Comparison of streptomycin and chloramphenicol in the prophylaxis 

of clinical disease. Trans. Assoc. Am. Phys., in press. 
Woodward, T. E. and Smadel, J. E.: Chapter. Rickettsial diseases of man, Harrison's Principles 

of Internal Medicine. Blakiston, 2nd Edition. 
Woodward, T. E.: Chapter. Leptospirosis, Meakins' Practice of Medicine, Mosby, Sixth Edition. 
WiswELL, J. C: The metabolic activity in vitro of some analogues of thyroxine, Am. J. Physiol. 

182: 301, 1955. 
AsPER, S. p., Jr. and Wiswell, J. C: Physiology and treatment of myxedema. Am. J. Med., 

20: 732, 1956. 
Wiswell, J. G. and Braverman, M. C: The effects of thyroxine and certain metal ions upon 

oxidation and phosphorylation in vitro, Endocrinology, 1957, in press. 
Thomas, W. C; Wiswell, J. C; Connor, T. B. and Howard, J. E.: H\'percalcemic crisis due 

to hj'perparathyroidism. Am. J. Med., 1957, in press. 
Greisman, Sheldon: Capillary observations in patients with hemorrhagic fever and other 

infectious diseases, J. Clin. Invest., June, 1957. 
Esmond, W. G.; Quintv, C. and Peters, H. R.: Hereditary spherocytosis in a Negro family, Am. 

J. Dis. of Children, 90: 407-410, October, 1955. 
Peters, H. R.: The Department of Medicine at Mercy Hospital, Md. State Med. J., 6: 3, March, 

1957. 
Ensor, R. E. and Peters, H. R.: Experience with the anticoagulant, Marcumar, Ann. Int. Med., 

May, 1957. 
Bessman, S. p.; Shear, S. and Fitzgerald, J. C: Effect of arginine and glutamate on the 

removal of ammonia from the blood in normal and cirrhotic patients. New Eng. J. Med. 256: 

941-943, 1956. 
Fitzgerald, J. C; Snyder, M. J. and Singleton, R. T.: Cholerasuis meningitis an unusual 

case with cure following surgical excision, Submitted Ann. Int. Med., 1957. 
Fort, Wetherbee: Constipation and the internist, Md. State Med. J., June 1955. 
Marriott, H. J.; Schubart, A. and Gorten, R.: Isorhythmic dissociation. Am. J. Med., 1957, 

in press. 
Bessman, S. P. and Stauffer, J. C: Factors affecting the appearance of ammonia in the gastric 

juice, J. Chn. Invest., 36: 874, 1957. 
Stauffer, J. C. and Belding, H. Scribner: Ammonium intoxication during treatment of 

alkalosis in a patient with normal Hver function. Am. J. Med., to be published. 

EDUCATIONAL ACTIVITIES 

February 7, 1957 Lisansky, E. Management of Psychosomatic Di\i- 

sion, Kecoughatan Veterans Hos- 
pital, Newport News, Virginia 

April 1, 1957 Lisanskv, E. Comprehensive Evaluation of Med- 

ical Problems, Wilmington Vet- 
erans Hospital Facility. Wilming- 
ton, Delaware 



departme:<t of medicise 



49 



Xo\ ember 29, 1956 Lisanskv, E. 



April 8, 1957 



Mav9. 1957 



June 8, 1956 



Fall of 1955 



xMarch 7, 1957 

October. 1956 
Februarv, 1956 
April. 1957 
April 14. 1957 
October 25, 1955 
Xo\"ember 17. 1955 
lanuarv 2-6. 1956 



Lisanskv. E. 



November 18, 1956 Lisanskv. E. 



Lisanskv. E. 



W^iswell. J. G.. and 
Asper. S. P.. Jr. 



Greisman. Sheldon 



Townshend, W . H., Jr. 

Gundrv. Lewis 
Gundr\ . Lewis 
Gundrv. Lewis 
Peters. H. Ravmond 
Peters. M. Ravmond 
Krause, Louis 
Krause. Louis 



Medical, Psvchiatric and Psvchologic 
Teamwork in the E\'aluation of 
Medical Problems. Fort Howard 
Veterans Hospital, Baltimore, Mary- 
land 

Psvchosomatic Evaluation and Man- 
agement of Medical Problems, 
North Virginia Clinical Assembly, 
Alexandria. V^irginia 

Anorexia Nervosa, Case Reports with 
Differential Diagnosis and Man- 
agement, Medical Research Club 
of Baltimore 

Comprehensi\ e Medicine. York 
Counts' Medical Societv, York, 
Pennsvhania 

The Metabolic Activitv in \ itro and 
in \ i\"o of the Acetic Acid Ana- 
logues of Thvroxine. Talk deli\ ered 
at the Meetino of the Endocrine 
Societv, Chicago 

Capillarv Alterations in Hemorrhagic 
Fe\er, Johns Hopkins LIniversity, 
School of Medicine, (Regional 
Meeting of the American College 
of Phvsicians) 

Problems in Staphvlococcal Infec- 
tions. Howard Countv Medical 
Societv 

Talk on Treatment of Diabetes. Ex- 
change Club of Highlandtown 

Talk on Tranquilizing Drugs, How- 
ard Countv Medical Societv 

Short Broadcast on Guard Your 
Health Month 

The Llse of Anticoagulants in Coro- 
nar\ Thrombosis. \\'B.\L-T\' 

Anticoagulant Therapv, Doctor's Hos- 
pital, Post-Graduate Institute 

Geriatrics, Hopkins Phvsics Depart- 
ment. Levering Hall 

Collagen Disease, X^isiting Chief, At- 
lantic Citv Hospital 



50 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 



February 21, 1956 

April 7, 1956 

April 26. 1956 

NWembcr 7, 1956 

November 13, 1956 
December 6. 1956 

February 4-8, 1957 
February 20, 1957 

January 7. 1955 

May, 1956 
May, 1957 
January, 1957 



Krause, Louis 

Krause, Louis 

Krause, Louis 

Krause, Louis 

Krause, Louis 
Krause, Louis 

Krause, Louis 
Krause, Louis 

Fort, Wetherbee 

Fort, Wetherbee 
Fort, Wetherbee 
Richardson, Aubrey D. 



April & May, 1957 Richardson, Aubrey D. 



June-July, 1955 



Woodward, T. E. 



Peripheral Vascular Disease, Visiting 
Lecturer, Uniyersity of North 
Carolina, Chapel Hill 

Psychosomatic Medicine and Geri- 
atrics, St. Frances General Hospital, 
Pittsburgh, Pa. 

Ancient Medicine, New Jersey OB 
and GYN Society, West Point, 
N. Y. 

Geriatrics, Delaware Association of 
General Practice, Wilmington, 
Delaware 

Panel on Gastro-Enterology, Southern 
Medical Association 

Psychosomatic Medicine, Eastern 
Panhandle Medical Society, Mar- 
tinsburg, West Virginia 

Peripheral Vascular Disease, Visiting 
Chief, Atlantic City Hospital 

Psychosomatic Medicine, Eye, Ear, 
Nose & Throat Society, Reading, 
Pennsylyania 

The Hernia Problem, Medical Rep- 
resentative on a Panel Presented 
at the Baltimore City Medical 
Society 

Pitfalls of Pheochromocytoma, Lec- 
ture to the Staff of the Church 
Home and Hospital 

Hypertension and Nephritis, Lecture 
to the Staff of the Church Home 
and I lospital 

Recent Advances in Cardiac Diag- 
nosis, An Address to the University 
of Maryland Nurses' Alumni So- 
ciety 

A Seven Weeks Course in Electro- 
cardiography for the Maryland 
General Hospital's House and Visit- 
ing Staff 

Lecture tour to Japan and Manila 



DEPARTMENT OF MEDICINE 



51 



November 1, 1955 



Woodward, T. E. 



November 22, 1955 Woodward, T. E. 



February 2, 1956 



March 1, 1956 



March 2, 1956 



March 2, 1956 



April 11, 1956 



Mav 24, 1956 



June 7, 1956 



Woodward, T. E. 



February 16, 1956 Woodward, T. E. 



Woodward, T. E. 



Woodward, T. E. 



Woodward, T. E. 



Woodward, T. E. 



Woodward, T. E. 



Woodward, T. E. 



Clues to Better Understanding of the 
Nature & Treatment of Certain 
Infectious Diseases, Annual Meet- 
ing, American Clinical and Clima- 
tological Society, Hot Springs, Va. 

Natural History of Louse Borne Epi- 
demic Typhus Fever, Natural 
History of Diseases Lecture Series, 
Johns I lopkins School of Hygiene 
& Public Health 

NRC Trauma Subcommittee Meet- 
ing to Consider Revision of Federal 
Civil Defense Emergency Treat- 
ment Manual, National Research 
Council, Washington, D. C. 

Conference on Hemorrhagic Fever, 
National Institutes of Health, Be- 
thcsda, Maryland 

Basic Considerations in Certain In- 
fectious Disease Processes, Wom- 
en's Medical Society of Maryland 

Antibiotics— Their LIse and Abuse, 
WMAR-TV-Baltimore City Med- 
ical Society 

A Symposium on Uses and Abuses of 
Antibiotics, Symposium, Baltimore 
Citv Medical Society 

Testimonv for the Committee on 
Labor and Public Welfare, U. S. 
Senate on National Medical Li- 
brarv. Old Supreme Court Cham- 
ber at the Capitol, Washington, 
D. C. 

Adxantagcs and Limitations of Anti- 
biotic Therapy, Allegany-Garrett 
County Medical Society, Fort Cum- 
berland Hotel, Cumberland, Mary- 
land 

Commencement Address, Staff, 
Henry Ford Hospital, Detroit, 

Michigan 



52 



BULLETIN OF THE SCHOOL OF MEDICINE, L7. OF MD. 



lune 15, 1956 



Woodward, T. E. 



Juno 20, 1956 



Woodward, T. E. 



September 6, 1956 Woodward, T. E. 



October 17, 1956 Woodward, T. E. 



October 26, 1956 Woodward, T. E. 



NoA-ember 1, 2, 3, 1956 Woodward, T. E. 



November 7, 1956 Woodward, T. E. 



No\cmbcr 12, 1956 Woodward, T. E. 



December 6, 1956 Woodward, T. E. 



Lecture on Pathogenesis and Manage- 
ment of Infectious Diseases, Dart- 
mouth Medical School and Vet- 
erans Administration Hospital, 
White River Junction, Vermont 

(1) Diagnosis, Pathogenesis and Man- 
agement of the Non-tuberculous 
Pneumonias; (2) Basic Considera- 
tions in Certain Infectious Disease 
Processes With Emphasis Upon 
Vascular Abnormalities, Trudeau 
Foundation, Post-Graduate Course, 
Saranac Lake, N. Y. 

Commission of Epidemiological Sur- 
vey, Department of Defense, Armed 
Forces Epidemiological Board, 
Washington, D. C. 

Practical Aspects of Diagnosis, Nature 
and Management of Acute Infec- 
tions, Maryland Academy of Gen- 
eral Practice, Sheraton-Belvedere 
Hotel, Baltimore, Marvland 

Therapy of Infections, New York 
Academv of Medicine, New York, 
N. Y. 

Panel Discussion on Pathogenesis of 
Typhoid Fever, American Clinical 
and Climatological Association, 
Skytop, Pennsylvania 

Infectious Diseases: Basic Considera- 
tions with Respect to their Patho- 
genesis, Diagnosis and Manage- 
ment, Se\'enth Scientific Assemblv, 
Academv of General Practice, Gar- 
den Citv Hotel, Vallev Stream, 
N. Y. ' 

Antibiotic Therapv, Practical Aspects 
and Basic Considerations, Southern 
Medical Association Meeting, 
Washington, D. C. 

Clinical Discussion of Pneumonia, 
Baltimore Citv Hospitals, Balti- 
more, Marvland 



DEPARTMENT OF MEDICINE 



53 



February 14, 1957 



Wooclv\ard, T. E. 



iMarch 18, 1957 

April 1, 1957 
April 25, 1957 

May 16, 1957 

March, 1957 



Woodward, T. E. 



Woodward, T. E. 



Woodward, T. E. 



Woodward, T. E. 



Stauffer, J. C. 



Basic and Practical Considerations in 
the Pathogenesis and Management 
of Certain Infectious Diseases, The 
Delaware Hospital, Wilmington, 
Delaware 

Practical /Xspects of Anti-Microbial 
Therapy: Artificial vs. Natural 
Methods, Hartford Hospital, Hart- 
ford, Connecticut 

Influence of Antibiotics on Immune 
Status, American Academy of Pe- 
diatrics, Washington, D. C. 

The Clinical Aspects of Human Lep- 
tospirosis, S\'mposium on Lepto- 
spirosis, LIniversitv of Kansas, Med- 
ical Center, Kansas City, Kansas 

The Problem of Getting Well From 
Infectious Diseases, Veterans Ad- 
ministration Hospital and Univer- 
sity of Syracuse, Syracuse, N. Y. 

Consciousness and the Chemical En- 
vironment of the Brain, Participa- 
tion in 25th Ross Pediatric Research 
Symposium, Baltimore, Md. 



DIVISION OF ARTHRITIS 



Personnel: 

Marriott, Henry J. L., M.D. 



Associate Professor of Medicine and 

Head of Division 
Director of Arthritis Clinic, OPD 



B. 



Kochman, Leon A., M.D. 
and Staff. 

Grants-in-aid: 

a. Public Health Serxice $7,020.00 

5,000.00 



b. Arthritis & Rheumatism Foundation 

C. Citrriciilar Activities: 

1. Outpatient instruction to assigned 4th \car students. 

2. Weekly seminars in rheumatic disease lor assigned 4th \car students. 

3. WeekK' consultatixe ward rounds. 

4. Particijiation in seminars, departmental and inlcr-departmental. 

D. Pxcscarcii Activities: 

Pilot stud\ on relation of blood groups to arthritic diseases. 

E. PiihJicatiuns: 
None. 



54 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF AID. 

F. Educational Activities: 

April 1947— Dr. Kochman conducted seminar for nurses at the Hospital for the 
Women of Maryland on the care of the arthritic patient. 

G. Needs of the Dixnsion: 
None. 

DIVISION OF CARDIOLOGY 

A. Personnel 

Leonard Scherlis, M.D Chief, Division of Cardiology 

Assistant Professor of Medicine 

William S. Love, M.D Professor of Clinical Medicine 

C. Edward Leach, M.D Assistant Professor of Medicine 

Chief, Adult Cardiology Outpatient Clinic 

Sidney Scherlis, M.D Assistant Professor of Medicine 

Chief, Pediatric Cardiology Outpatient Clinic 

Wilfred H. Townshend, M.D Associate in Medicine 

Stephen J. VanLill, III, M.D Associate in Medicine 

Kyle Y. Swisher, M.D Associate in Medicine 

Aubrey Richardson, M.D Instructor in Medicine 

Robert T. Singleton, M.D Trainee in Cardiology 

Luis F. Gonzalez, M.D Trainee in Cardiology 

B. Grauts-in-aid-1956-1957 

Source : Amount Title 

National Heart Institute $25,000.00 Cardiovascular Training Grant 

U. S. Public Health Service 11,500.00 Studies in Blood Volume and 

Blood Cell Mass 
National Heart Institute 4,100.00 Traineeship in Cardiology 

C. Ctirricidar Actix'ities 

The Division of Cardiology is responsible for the laboratory instruction in the 
physiology course devoted to the electrical activity of the heart. In addition, a 
lecture on electro-physiology and electrocardiology is given. That portion of the 
physical diagnosis course devoted to the cardiovascular system is given by the 
Division of Cardiologv to the sophomore class. The junior class receives several 
formal lectures in cardiology and five informal clinics and conferences. They are 
consigned to hospital wards where they are in contact with consultants in cardiology. 
There are weekly ward rounds with the seniors on cardiology problems. Thev rotate 
through the adult and pediatric cardiac clinics where conferences are held. An 
elective course in electrocardiography is given which is attended by an average of 
seventy-five students and house-staff. Two students, usually seniors, are appointed 
as Summer Fellows in the Division of Cardiology participating in active investi- 
gation and receivina clinical instruction. 



DEPARTMENT OF MEDICINE 55 

D. Research Activities 

1. Studies in Blood Volume and Red Cell Mass. This study is supported by the 
National Heart Institute. 

2. Neurogenic Aspects of Coronary Artery Disease. This is supported by a Grant 
from the Maryland Heart Association given in 1955. 

3. Ouinidine Metabolism and Tissue Gradient Studies. A preliminary study was 
started and support has been received for the coming year from the Marvland 
Heart Association. 

4. An evaluation of Spatial Vectorcardiography in the Diagnosis of Myocardial 
Infarction. A general evaluation of this electrocardiographic technique. 

5. The Division has continued to perform the cardiac catheterizations for diagnostic 
and in\'estigational purposes. 

E. PnhUcations-]u\y 1, 1955 to June 30, 1957 

ScHERLis, S. and Cowley, R. A.: Experimental and clinical observations of neurogenic 

factors in coronary artery disease, Surgery, 38: 835, 1955. 
ScHERLis, S.: Experimental findings and clinical results of selective vagotomy. (Abstract) 

Circulation, 12: 770, 1955. 
ScHERLis, L.; Cowley, R. A.; Richardson, A.; Adams, C. and Love, W. S.: The spatial 

vectorcardiogram and electrocardiogram in mitral and aortic vaKoilar disease. (Abstract) 

Circulation, 12: 770, 1955. 
Cowley, R. A.; Scherlis, L. and Hackett, P.: The evaluation and care of the patient for 

surgery. The American Surgeon, 21: 242, 1955. 
Scherlis, L. and Cowley, R. A.: The Lutembacher Syndrome: A physiologic study and case 

report. Annals of Internal Medicine, 43: 575, 1955. 
Scherlis, L.: Spatial vectorcardiography, Modern Medicine, p. 172, 1957. 

F. Lectures and Conferences Conducted by Mevihers of the Division 
July 1, 1956 to June 30, 1957 

Januarv 3, 1957 Scherlis, L., St. Agnes Hospital. "Pericarditis." 

March 5, 1957 Scherlis, L., Combined Anesthesia Conferences of Baltimore. 

"The Surgical Patient with Heart Disease." 
March 13, 1957 Scherlis, L., Loch Raven Veterans Hospital. "Interatrial 

Septal Defects." 
April 16, 1957 Scherlis, L., Marvland General Hospital. "Pericarditis." 

May 15, 1957 Scherlis, L., American College of Cardiologv, Washington, 

D. C. "Seminar on Electrocardiographv and Vectrocardi- 

ography." 
May 16, 1957 Scherlis, L., American College of Cardiologw W^ishington, 

D. C. "Spatial Vectorcardiography as a Diagnostic Aid in 

Mvocardial Infarction." 
May 17, 1957 Scherlis, L., Pro\ident Hospital, House Officers Association. 

"Cardiac Catheterization." 
June 13, 1957 Scherlis, L., Mercy Hospital Post-Graduate Course. "Myo- 

cardial Infarction." 
September 26, 1956 Scherlis, L., Delaware Academy of General Practice. "Basic 

Physiology as applied to Cardio\ascular Diseases." 



56 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 



October 1, 1956 
October 18. 1956 
Feb. 19-/\pril "57 
May 8, 1957 

February 22, 1957 

February 28, 1957 
January 23, 1957 

October 5, 1956 

AuPust 27, 1956 

November, 1956 

October 16, 1956 
November 14, 1956 

May 22, 1957 

Scientific Exhibits 
October 18, 1956 



Swisher, K. Y., Alumni Association of Church Home. "Cura- 
ble Forms of Heart Disease." 

Swisher, K. Y., St. Agnes Hospital. "Cor Pulmonale: Patho- 
senesis. Diagnosis and Treatment." 

Richardson, A., Maryland Ceneral Hospital. "Weekly Course 
in Electrocardiography." 

Scherlis, L., Anne Arundel County Med. Soc. & U. S. Naval 
Hospital, AnnapoHs, Md. "Referring Cardiac Patients." 

Non-Scientific Papers Delivered 
Scherlis, L.; Richardson, A.; Swisher, K., Maryland Heart 

Association, WMAR-TV. "Help Your Heart." 
Scherlis, L., WAAM-TV. "New Hope for the Young Heart." 
Richardson, A., Baltimore Talmudical Society. "Recent Ad- 
vances in Diagnosis and Treatment of Heart Disease." 
Swisher, K., Woman's Civic League of Baltimore. "Recent 

Advances in Diagnosis and Treatment of Heart Disease." 
Scherlis, L., Doefield Democratic Club. "Recent Advances in 

Cardiovascular Disease." 
Scherlis, L., Chizuk Amuno Brotherhood. "You and Your 

Heart." 
Scherlis, L., Golden Age Club. "Heart Disease." 
Scherlis, L., Rotary Club of Catonsville. "Recent Advances 

in Cardiac Disease." 
Scherlis, L., Frederick Countv Heart Association. "The Marv- 

land Heart Association." 



October 18, 1956 



Scherlis, L., Maryland Heart Association, Post-graduate 
Seminar in Cardiology. "Electrocardiography as an aid in 
the evaluation of cardiovascular disease." 
Scherlis, S., Maryland Heart Association, Post-graduate 
Seminar in Cardiologv. "Coronary Artery Disease." 
H. Committees 

The members of the Division of Cardiologv have been active in the Maryland 
Heart Association. Dr. Sidney Scherlis is a member of the Medical Advisorv 
Board and is Chairman of the Lay Education Committee. Dr. Leonard Scherlis 
is Chairman of the Community Services Committee, serves as a member of the 
Research Committee, and is a member of the Board of Trustees. Dr. Aubrey 
Richardson is a member of the Community Serx'ices Committee, and Dr. Kyle 
Swisher is a member of the Professional Education Committee. During the past 
year, grants were received for research projects to be initiated July 1, 1957 and 
support has been secured for a Fellow in the Di\ision of Cardiologv from the 
Maryland Heart Association. 



DEPARTMENT OF MEDICINE 57 

I. Clinic Areas 

The Division of Cardiology is active in the Aduk and Pediatric Cardiology 
Clinic. Members of the Division help in the instruction of students and hold 
weekly conferences in these clinics. The clinic areas include facilities for both 
electrocardiograms and fluoroscopic examination and evaluation. Approximately 
1,620 patients were seen from July 1, 1956 to June 30, 1957. 

J. Recouniiendations 

Space: The present space occupied by the Division of Cardiology is inadequate. 
The personnel which is active in the Division has insufficient space for the recording 
of electrocardiograms, sound tracings, and routine patient consultations. Projects 
alreadv appro\'cd and underway, require laboratory space which is not presently 
available. There is a present urgent need for an additional office, consultation room, 
and laboratory. 

The routine electrocardiograms are recorded for the hospital in an area which 
is now overcrowded and inadequate. With the personnel also increased to include 
assistant residents, rotating through specialty ser\'ices and assistant residents from 
Church Home and Maryland General, the space problem becomes further acute. 

Equipment: At the present time, there is no specific need for electrocardio- 
graphic equipment. The present and proposed Grants-In-Aid should be sufficient 
for the contemplated equipment needs of the division. 

Personnel: The increased routine and investigational work of the division 
requires the services of another non-professional member of the staff. A technician- 
secretary is required in order to keep the files and records available and to record 
and mount electrocardiograms for teaching purposes. 

The present medical stenographer is funded from the teaching grant of the 
United States Public Health Service. Her work load has so increased that she is 
barely able to keep up with the routine work of the division. 

Teaching Load: It is contemplated that the teaching load of the division will 
be increased. This is not only along the student level but along the house-staff 
level as well. Walking cardiac rounds are to be held regularly. It is planned by 
the division to ha\'e a weekly cardiology conference, to which will be invited 
interested members of other divisions. Permission has been secured for a post- 
graduate electrocardiographic course and it is hoped that this will be inaugurated 
during the coming year and possibly expanded into the Cardiology Post-graduate 
Courses as well. During the past year, assistant residents from Maryland General 
and Church Home participated in the activities of the division. It is assumed that 
this will probably continue and possibly be expanded. This increased teaching load 
mav require additional professional personnel. 

DIVISION OF CLINICAL PATHOLOGY 

July 1, 1955-June BO, 1957 
I. Personnel: 

Dr. Milton S. Sacks, Professor of Clinical Medicine and Head of Di\ision 
Dr. Marie A. Andersch, Associate Professor of Biochemistrx- in Medicine 



58 



BULLETIN or THE SCHOOL OL MEDICINE, I/. OF AID. 



Dr. CaiTdll L. Spiiiliiii;, Assisl.ini I'rolossor ol Medicine 

Dr. Charles L. Wisseman v,i"»art time). Professor of Mierobiology 

Dr. Alice M. Band (deceased June 9. 1957), Associate in Medicine 

Dr. W. W. Schier (^ part time). Assistant Professor of Medicine 

Dr. John n. DellolV (^jxirt-time). Associate in Medicine 

Dr. Benjamin Rotlifeld ^part-time), /Assistant in Medicine 

Dr. Stanlex Miller (^part-time), A.ssociate in Medicine 

Dr. Sherwood Miller, Baltimore Kh LahoratorN' Fellow in Medicine 

^july 1, 1955-June 30, 1957) 
Dr. Howard Cohn, Baltimore Rh Laboratory Fellow in Medicine ^JiiK 1, 1957) 
Dr. Elias Guttman, Baltimore Rh Laboratory Fellow in Medicine (July 1, 1957) 
Elsa F. Ldin, B.S., Research .Associate in Clinical Pathology 
Jason M. Masters, M.S.. Instructor in Medicine 
Audrey Funk, B.A., /■Xssistant in Medicine 

.Adam Szczvpinski, Laboratory 1 cchnician I Cecelia Castillo, Laboratory Technician 11 

Lcnorc A. Schwartz, Laboratory 1 cchnician I Enrica S. Tantoco, Laboratory 1 echnician 11 

Geneyieye M. Clement, Laboratory T cchnician I 1 lannah N. Allman, Laboratory Assistant 

Emily Boyle, Laboratory Technician 1 Julianna l\. Claeser, LaboratoPt' Assistant 

Lorraine D. Gordon, Laboratory Technician I Janice M. Bona, Laboratory Assistant 

Mary E. Lochte, Laboratory Technician I Eleanor Plewacki, Laboratory Assistant 

Eleanor S. Flagg, Laboratorv 1 echnician I Suzanne M. Allynarczyk, Laboratory Assistant 

Kathryn Dorsey, Laboratory 1 echnician I NLiry Meeks, Laboratory Assistant 

Kathleen A. O'Connor. Laboratory 1 echnician I Mary Larrich. Laboratory Assistant 

iAnn L. Gilbert. Laboratory 1 cchnician 1 Katherine Roelke, Laboratory Assistant 

Doris L. McKay. Laboraton' T echnician I Zada K. StouHer, Medical Stenographer 

Lois L'Lene Filer. Laboratory 1 echnician II Janice S. Schwartz. Senior Typist 

Marie A. Check. Laboratory Technician II Liyia Frevman. Junior Typist 

X'elma E. Days. Laboratory Technician II Richard Babb, Laboratory Helper 

Rosa E. Tayera, Laboratorv- Technician II Margaret Nichols, Laboratory Helper 

Mary E. James, Laboratory Technician II Minyon Kelly, Seryice \\\>rker 

Shirley H. Simon, Laboratory Technician II Zulccn McCaskill, Service Worker 
Mary E. Armsworthy, Laborator\- Technician II 

II. Statistical Suuniiary of Work: 

Jan. 1, r)SS Jan. 1, 1956 Jan. 1, 1956-Jan. 1, 1957 

Bacteriology 32,03.3 36,136 

Biochemistry 80,852 84,072 

Blood Bank 60,547 58,325 

Coagulation Laboratorx 767 (2mos. operation) 6,165 

Hematology 80,801 84,248 

OPD Laboratory 56,1 1 1 64,592 

Serology 28,172 31,817 

Urinalysis Laboratory 81,639 91,549 

420922 4577840 

Percentage increase in xolume of work— I955T956 8.7% 

Percentage increase in \()lumc of work— 1950 1956 86.5% 



DEPARTMENT OF MEDICINE 59 

III. New diagnostic procedures introduced: 

Serum transaminase 

Hemoglobin c-lcctro[ili()rcsis 

Serum electrophoresis 

Serimi Iron 

Iron biiulinc^ capacity 

Serum copper 

Protein bound iodine 

C— reactive protein 

Thromboplastin (icneration Test 

Prothrombin Consumption Test 

Electronic computation ol red cells and white cells 

IV. Ciirricuhir Activities: 

a. Clinical Pathology— sophomore class— 128 hours 

b. Advanced Clinical Pathology— junior class— 36 hours 

c. Hematology conferences— senior class— 32 hours 

d. General Medicine (lectures, clinics)— junior class— 5 hours 

e. Hematology staff rounds (house staff consultation)— 2 hours per week— 12 
months 

f. Proportional participation— weekly grand rounds in Medicine (Tuesday noon 
conferences) 

g. Proportional participation— Saturday morning— inter-departmental seminars 
h. Participation in Basic Science program of Department of Obstetrics— Gyne- 
cology— 12 hours— junior class 

i. Partici|xition— Basic Science program of Post Ciraduate Committee. 

V. Cirants-in-Aid: 

a. Maryland Division, American Cancer Society— $4300.00— Leukemia 
Research. 

b. Ayerst Laboratories-$7,500.00-Iron Metabolism 

c. Anna Corman Memorial Fund— $3,000.00— research fellowshij) 

d. Baltimore Rh Laboratory— $15,000.00— General Llematology Research I und 
c. Baltimore Rh Laboratory— $6,500.00— support of two fellowships 

VL Wesearch Activities: 

a. Vitamin Bj^ hlood levels in leukemia and allied diseases— i\\e. Euglena gracilis 
var. Z microbiologic assay technique is being employed. High blood levels of the 
vitamin have been found in chronic myeloid leukemia which seems to be related to 
an increased binding-capacity of an alpha globulin in this disease. The results of this 
study are in press (J. Lab. & Clin. Med.) at the time this report was prepared. Further 
studies are contemplated. 

b. Immunologic studies in Hodgkin's disease— \xnicnts with 1 lodgkin's disease show 
a lack of reactivity to tubercidin. Attempts to transfer tuberculin sensitivity bv means of 
concentrated leukocyte suspensions from tuberculin |K)siti\e indi\ iduals to patients 



60 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

w ith I lodukin's disc.isc arc being iikkIc. In this manner it is hoped we can explore the 
tissue reactivitx' of patients with this disease. 

c. Cooperative Cheiiiotherapy Prooraw in Acute Leukemia— We are cooperating 
with a chemotherapx' panel consisting of representatives from the National Cancer 
Institute. Walter Reed Hospital, Roswell Park Memorial Institute, Duke Hospital, 
jert'erson I lospital in stucK ing new agents in the management of Acute Leukemia. The 
drug currently being studied is 6-Azauracil. 

d. Antigenic Content of human leukocytes— Norm-a\ leukocytes have been found 
to react with anti-A and anti-B agglutinins. The probable presence of the antigens A 
and B in leukocytes must be taken into consideration when examining sera in the 
search for immune leukoagglutinins. A paper on these studies is in preparation at the 
time of preparing this report. 

e. Starcli gel electrophoresis of plastna proteins— recent reports indicate that there 
are genetic differences in human plasma proteins. The techniques for this type of study 
are being set up at present. 

f. The Nature of the Red Cell Defect in Paroxysmal Nocturnal Heinoglohimiria— 
in \itro inhibition of the Ham (Acid Hemolysis) test by alpha tocopherol has been 
observed. Studies are in progress to determine whether similar reversal occurs after the 
administration of alpha tocopherol in vivo. 

VII. Publications-] uly I, 1955-]une 30, 1957: 

1. Sacks, Milton; Raccuglia, G.: Hereditary Deficiency of Proaccelerin (Parahemo- 
philia): A Family Study, J. Lab. & Clin. Med., 46: 98: 1955. 

2. Sacks, Milton S.: Fibrinogen Deficiency, Ann. Int. Med., 43: 1139: 1955. 

3. Andersch, Marie A.: A titration Method for the Determination of Calcium in Serum 
using a New Indicator, J. Lab. & Clin. Med., 49: 486: 1957. 

4. Raccuglia, C; Sacks, Milton S.: Vitamin B12 Binding Capacity of Normal and 
Leukemic Sera, J. Lab. & Clin. Med., 50: 69: 1957. 

VIII. Educational Activities-July 1, 1955-June 30, 1957: 

1. October 4, 1955 Sacks, Milton S.: Medical Research Club. 'Tibrino- 

gen Deficiency." 

2. October 20, 1955 Sacks, Milton S.: York County (Pa.) Medical So- 

ciety. "Recent Developments in the Diagnosis and 
Management of Hemorrhagic Diathesis." 

3. October 25, 1955 Sacks, Milton S.: Post Graduate Institute, Doctor's 

Hospital. "Recent Advances in Knowledge of Blood 
Coagulation." 

4. Nov. 4, 11, 18, 1955 Sacks, Milton S.; Spurling, Carroll L.: Medical Staff 

Conferences, Provident Hospital. "Lymphoma. 
Anemias, Hemoglobinopathies." 

5. Novembe; 17, 1955 Sacks, Milton S.: Baltimore City Medical Society, 

General Practice Section. "Some Aspects of Iron 
Metabolism." 

6. November 19, 1955 Sacks, Milton S.; RaccugHa, G.: Regional Meeting, 

American College of Physicians, Baltimore. "Scrum 
Vitamin B,._) Le\'els in Leukemia." 



DEPARTMENT OF MEDICINE 



61 



7. December 2, 1955 

8. December 14, 1955 

9. January 9, 16, 1956 

10. January 11, 1956 

11. January 26, 1956 



12. January 26, 
February 2, 
February 9, 1956 

13. February 6, 1956 

14. March 16, 1956 



15. March 19, 1956 

16. March 21, 1956 

17. April 4, 1956 

18. April 19, 1956 

19. April 28, 1956 

20. May 29, 1956 

21. October 10, 1956 



Band, Alice M.; Sacks, Milton S.: American Medical 
Association, Clinical Meeting, Boston, Mass. "The 
Management of Idiopathic Thrombocytopenic 
Purpura." 

Sacks, Milton S.: Joint Staff Conference, Obstetrics 
and Pediatrics, Union Memorial Hospital. "The 
Rh Problem." 

Sacks, Milton S.: Johns Hopkins Unixersity School 
of Medicine, Junior Class. "Blood Group Iso- 
immunization." 

Sacks, Milton S.: Union Memorial Hospital, Medical 
Meeting. "Management of Leukemia." 

Sacks, Milton S.: Sinai Hospital Staff Meeting. "The 
Physiology of Blood Clotting and its disorders" 
(Panel discussion). 

Sacks, Milton S.; Spurling, Carroll L. : St. Agnes 
Hospital, Medical Programs. "Lymphoma, Anemia, 
Collagen Diseases. ' 

Sacks, Milton S.: Baltimore City Dental Assistants 
Society. "Genetic Factors in Disease." 

Sacks, Milton S.; Spurling, Carroll L.: Maryland 
State Department of Health. "Workshop on Blood 
Grouping and Allied Subjects." 

Sacks, Milton S. : Baltimore City Medical Society, 
Dermatology Section. "Gamma Globulin and its 
Re'ation to Skin Diseases." 

Sacks, Milton S.: Post Graduate Seminar, Depart- 
ment of Neurology, Neuro-Pathology, Neurosur- 
gery, University of Maryland. "The Diagnosis of 
Disseminated Lupus Erythematosus." 

Sacks, Milton S.: Catholic Hospital Association of 
the LInited States and Canada, Blood Bank Work- 
shop, CTCorgetown University, Washington, D. C. 
"Miscellaneous Blood Groups and Their Aspects 
in Blood Transfusion. ' 

Sacks, Milton S. : U. S. Naval Hospital, Bainbridge, 
Maryland, Staff Meeting. "New Red Cell Antigens." 

Sacks, Milton S.: Medical Association of Lutheran 
Hospital, Annual Meeting. Discussion of paper by 
Dr. Leandro M. Tocantins on "Fundamental and 
Clinical Asjxxts of HemophiHa. " 

Sacks. Milton S.: Church Home and Hospital. 
"Granulomatous Diseases." 

Sacks. Milton S.: Union Memorial Hospital, Ob- 
stetrical Staff Conference. "The Rh Factor." 



62 BULLETIN OF THE SCHOOL OF MEDICINE. V. OF MD. 

22. October 17, 1956 Sacks, Milton S.: Delaware Academy of General 

Practice, Wilmington. Delaware. "Common Blood 
Dvscrasias: Diagnosis and Management." 

23. i\o\ ember 2, 1956 Sacks, Milton S.: Baltimore City Medical Society. 

"I lemorrbagic Disorders" (Panel Discussion). 

24. November 7, 1956 Sacks, Milton S.: Union Memorial 1 lospital, Medical 

Staff Conference. "Drug Induced Blood Dyscrasias. ' 

25. Dec. 10, 17, 1956 Sacks, Milton S.: Johns Hopkins University School 

of Medicine, Junior Class. "Blood Group Iso- 
immunization. 

26. December IB, 1956 Sacks, Milton S.: Maryland Academy of General 

Practice (Post Graduate Committee). "Blood 
Diseases." 

27. Februar) 27, 1957 Sacks, Milton S.: St. Agnes Hospital, Obstetrical 

Staff Meeting. "The Rh Factor." 

28. March 13, 1957 Sacks, Milton S.: Eastern Panhandle Medical So- 

ciety (West Virginia). "Recent Developments in 
the Studv of Hemorrhagic Diseases." 

29. April 23, 1957 Sacks, Milton S.: Bon Secours Hospital, Staff Meet- 

ing. "Afibrinogenemia." 

IX. Sface: 

The space of the Division of Clinical Pathologv is hopelesslv inadequate. We have 
continued to point this out in our annual budgetary requests in recent years. This view 
has now also been endorsed by the recent report of Dr. Kenneth Babcock, Director of 
the Joint Commission on Accreditation of Hospitals (item No. 7, report of May 14, 
1957). In 1935, the first full year of operation of the new Universit)' Hospital, approxi- 
mately 65,000 tests were done. In 1956, 457,000 tests were done, an increase of 
approximatelv 700%! There has been no increase in the space of this division since 
1935. We have now reached a point where manv of our laboratories are so crowded 
with personnel that no further increases can be accommodated. It appears to us that 
this has now become an important limiting factor in the expansion of the patient load 
of the hospital. The probable establishment of a School of Medical Technologv and 
the institution of a two vear residcncx inogram in Clinical Pathologv, in collaboration 
with the Department of Pathologv, will still further aggra\'ate this serious problem. 

The present space allotted to the Division of Clinical Pathology in both the hospital 
and the out patient department is estimated to be between 5500 and 6000 square feet. 
Our need, based on estimated growth during the next 15-20 vears is approximately 
25,000 square feet. 

The needs of one area of the Dixision arc c\cn more j^rcssing than the overall 
jiicture. I refer to the Blood Bank. This is an important area of contact between the 
University Hospital and the general public. Approximatelv 7500 blood donors are 
drawn yearly in this area. Our facilities will not permit proper processing of the blood. 
We have always maintained a high reputation in this field and it is distressing to 
contemplate anv deterioration for lack of adequate phxsical facilities. 



DEPARTMENT OF MEDICINE 63 

DIVISION OF DERMATOLOGY 

A. Personnel 

Harry M. Robinson, Jr., B.S., M.D Professor of Dermatology 

Head of the Division of Dermatology 

Francis A. Ellis, B.S., M.D Associate Professor of Dermatology 

Asisstant Professor of Pathology, in 
charge of Dermal Pathology 

Raymond C. V. Robinson, B.S., M.D Assistant Professor of Dermatology 

Assistant Chief of Dermatology Clinic 

Eujiene S. Bereston, A.B., M.D., D.Sc Assistant Professor of Dermatology 

Albert Shapiro, M.D Assistant Professor of Dermatology 

Mark B. Hollander, B.S., M.D Associate in Dermatology 

William R. Bundick, M.D Associate in Dermatology 

Stanley N. Yafle, M.D Instructor in Dermatology 

Morris M. Cohen, M.D Instructor in Dermatology 

David Bacharach, M.D Instructor in Dermatology 

John F. Strahan, M.D Instructor in Dermatology 

Lee R. Lerman, M.D Assistant in Dermatology 

Jacob Ludwiu, M.D Assistant in Dermatolooy 

Louis E. Harmon, M.D Fellow in Dermatology 

Ken Hashimoto, M.D Assistant Resident in Dermatology 

B. Graiits-ln-A'ul 

Amount Title 

LIpjohn Company $2,400.00 Research in Steroids 

Chas. Pfizer Company 2,000.00 Research in Steroids 

Merck, Sharp and Dohme Co. 3,000.00 Research in Steroids 

Miss Paula Von Klein 500.00 A gift for dermatology education 

Thc Duke Co 500.00 A gift for dermatology education 

Maltbie Laboratory 3,000.00 Research on fungicides 

Parke, Davis Co 2,000.00 Study on the \'alue of Camocjuin in 

Discoid Lupus Erythematosus 

C. Curriciihir Acth'itY 

Members of the Di\ ision ha\c |)articipalecl in the leaching of dermatologN' to 
the junior and senior classes of the medical school. Dail\ rounds are made in the 
hospital b\' one of the senior staff members on all serxice consuhations and |)ri\ate 
patients. DaiK teaching is done in the out-patient department to groups of twelve 
senior students who are assigned to dermatology for a period of lour weeks each. A 
two hour clinical session is held once weekly with one cpiarter of the junior class. 
I his grou|i rotates e\'ery nine weeks. The members of the di\ ision ha\e participated 
in lectures to the house olllcers. 

An actixe training program is conducted at the postgraduate le\el for residents 
and fellows in dermatology The Dixision of Dermat()U)g\' has been appro\ed by 
the American Board of DermaiologN for the three \'ears of training required by that 
organization. 



HEALTH SCIENCES LIBRARY 

JUNIVERSITY OF MARYLAND 

BALTIMORE 



64 nULLETl^^ OF THE SCHOOL OF MEDICII^E, U. OF AID. 

D. Research Activities 

1. Clinical and laboratorx' c\al nation of antibiotics in the treatment of acne 
vulgaris. Present studies in this dixision indicate that there is apparently no 
correlation b\ the tube dilution sensitixitv tests and the antibi(^tic selected. 
Homeopathic doses appear to produce and retaiii inipro\enient. Penicillin has 
proved to be oF least \alue. 

2. Studies are being conducted on the in \ itro nutritional reciuirements of fungi. 
In the course of our present studies \vt ha\e arri\ed at the quantitative require- 
ments of \-itamins and minerals as necessarx additions to the culture media 
now in use. 

3. Further studies are being conducted to determine the effect of dermatophytes 
on melanin. Present in \itro studies indicate definite interference with the 
tsTosin-tvrosinase reaction. 

4. The mode of action of steroids applied topically is being studied in humans and 
lower animals. Further studies are contemplated using tagged compounds, serial 
biopsies, and the direct photographic technique. An attempt is being made to 
determine the retention of steroids in superficial tissue when applied topically. 

5. The affinity of inorganic arsenic for keratin is under study. The paucity of 
clinical material will make this a long term project. An attempt is being made to 
prove or disprove claims made for the affinity of inorganic arsenic for keratin. 

6. The relationship of cutaneous lesions to emotional stimuli is under study. Dr. 
Charles Betts of the Department of Ps\chiatry has been assigned to work with 
the Division of Dermatolog)'. He is at present holding regular rounds with the 
members of the staff and trainees once weekly for two hours. 

7. Studies on the epidemiology of microsporum audouini infection are being con- 
ducted. At present we have been able to prove the role of fomites in the spread 
of this contagious disease. We are attempting to prove or disprove the possi- 
bility of infecting lower animals. These studies are being conducted on hamsters, 
rabbits, and guinea pigs. At a later date it is hoped to also conduct studies on 
monkeys. 

8. Clinical investigation on the role of tranquilizing drugs is still in progress. i\t 
present four different compounds are being used. This study has been an 
interesting one and in view of the number of placebo reactors, it has been 
difficult to exaluate. 

E. Piihlications 

1. Robinson, H. M., Jr.: Prednisone and Prednisolone in the treatment of dematoses. First 
International Conference on the Clinical and Metabolic Effects of Meticorten and 
Meticortelone, New York Cit)', June 1955. 

2. Robinson, R. C. V.: Comparative study of (jintment bases, A. M. A. Arch. Dermat. 72: 
54-58. 

3. Zeligman, Israel:' Cortisone therapy for pruritic pityriasis rosea. Bull. Sch. of Med., 
Univ. of Md., 40: 76-77, July 1955.' 

4. Robinson, R. C. V.: Plastibase— A hydrocarbon gel ointment base. Bull. Sch. of Med., 
Univ. of Md., 40: 86, July 1955. 

5. Robinson, H. M., Jr.; Robinson, R. C. V. and Strahan, J. P.; Indications for local 
hydrocortisone therapy. Medical Times, 83: 227-237, 1955. 



DEPARTMENT OF MEDICINE 



65 



6. Bereston, Eugene S.: Hydrotherapeutic action of crude coal tar in selected dermatoses. 
New York State Jour, of Sled., 55: 1724, 1955. 

7. Robinson, H. M., Jr.: Antibiotika und steroide in der dermatologischen prai.xs. Die 
Therapiewoche, 5: 630 (1955). 

8. Zeligman. Israel and Robinson, H. M., Jr.: Liquid nitrogen therapy in dermatology. 
Bull. Sch. of Med., Univ. of Md., 40: 5, Oct. 1955. 

9. Robinson, H. M., Jr. and Hollander, Mark, B.: Topical use of chlorquinaldol. Jour, 
of Invest. Derm., 26: 2. Feb. 1956. 

10. Robinson, H. M., Jr.; Cohen, Morris M.; Robinson, R. C. \'. and Bereston, 
Eugene S.: Simplified office procedures for mvcological diagnosis. J. Am. Med. Asso., 
1^.0: 537-540. Feb. 1956. 

11. Robinson, H. M., Jr.; Robinson, R. C. \'. and Strahan, John. F: Antibioticsteroid 
combinations for topical use. Antibiotics Annual. 302: 1955-1956. 

12. Robinson, H. M., Jr.; Robinson, R. C. V. and Strahan, John F.; Hydro.wzine 
(Atara.x) hydrochloride in dermatological therapy. 1. Am. Med. Asso., 161: 604-606, 
June 1956. ' 

13. Ellis, Francis A. and Bundick, \V. R. : Cutaneous elasticity and hvperelasticitv. 
A. M. A. Arch. Derm., 74: 22-32, 1956. 

14. Robinson, R. C. V.; Robinson. H. M., Jr. and Strah.\n, John F.: Amodeoquin 
(camoquin) in discoid lupus ervthematosis. Bull. Sch. of Med., Univ. of Md., 42: 14-16, 
Jan. 1957. 

15. Robinson, R. C. \'.: Nystatin in the treatment of cutaneous moniliasis. Monographs on 
Therapy. 2: 55 59, Mar. 1957. 

16. Robinson, R. C. V.: Moniliasis in infants. .Am. J. Pediatrics, In press. 

17. Robinson, H. M., Jr. and Robinson, R. C. V.: Fludrocortisone in dermatoses. Mono- 
graphs on Therapy, On press. 



F. t.Llucat':oiiaJ Activities— Lecture^.. Seminars, Conterences to Medical Groups 
1. September 3, 1955 



Robinson, H. M., Jr.: German Therapy \\^eek at Karl- 
shrue, Germany, "Antiobiotic and Steroids in the 
Practice of Dermatology." 

Robinson, H. M.. Jr.: Connecticut Academy of General 
Practice, Hartford, Conn., guest speaker. "Recent .\d- 
\ances in the Treatment of Skin Eruptions." 

Robinson, 11. M., Jr.: Beginning of a series of ten 
lectures on Dermatology to the nurses of St. Agnes 
Hospital. 

Robinson. 1 I. M., Jr.: Beginning on this date six lectures 
on Dermatology to the nurses at Union McnuMial 
Hospital. 

Robinson, 11. M.. Jr.: Southern Medical .Association, 
Houston. Texas, discussion of paper "Sebi/on in 
Seborrheic Dermatitis." 

Ellis. Francis A.: Stuithern Medical Association. Hous- 
ton. Texas. \ice president i>f the section on derma- 
tolog\ . member of the panel on histopathologv. 
7. Noyember 9. 1955 Robinson, R. C. \^: Southern Medical Conference, 

Houston, Texas, p.iper presented "Topical Steroid 
Therapy. 



2. October 20, 1955 



3. October 21, 1955 



4. October 21, 1955 



5. No\ ember 9, 1955 



6. Noyember 9. 1955 



66 



RULLETl!< OF THE SCHOOL OF MEDICINE, V. OF MD. 



8. No\ ember 9, 1955 

9. November 9, 1955 

10. December 6, 1955 

11. December 7, 1955 

12. December 8, 1955 

13. December 7, 1955 

14. December 8, 1955 

15. December 9, 1955 

16. January 3, 1956 

17. February 24, 1956 

18. February 24, 1956 

19. March 4, 1956 

20. March 10, 1956 

21. March 10, 1956 



Robinson. I I. M., Jr.: Southern Medical Association, 
Houston, lexas, co-author of paper on "Topical 
Steroid Therapy." 

Strahan, John F. : Southern Medical Association, Hous- 
ton, Texas, co-author of paper on "Topical Steroid 
Therapy." 

Robinson, W. M., Jr.: American Academy of Derma- 
tolog\' and Svphilology, Chicago, 111. Lecture "Topical 
Steroid Therapy." 

Robinson, H. M., Jr.: American Academy of Derma- 
tology and Svphilology, Chicago, 111. Lecture "The 
Treatment of Granuloma Inguinale." 

Robinson, H. M., Jr.: American Academy of Derma- 
tology and Syphilology, Chicago, 111. Lecture "Pred- 
nisone and Prednisolone in the Treatment of Derma- 
toses." 

Ellis, Francis A.: American Academy of Dermatology 
and Syphilology, Chicago, 111. Participant Teacher in 
the Course on Dermal Pathology. 

Ellis, Francis A.: American Academy of Dermatology 
and Syphilology, Chicago, 111. Lecture "Special Prob- 
lems in Dermal Pathology." 

Bereston, Eugene S.: American Academy of Derma- 
tology and Syphilology, Chicago, 111. "Nystatin in 
Candida Albicans Infections." 

Ellis, Francis A.: Mexican Dermatological Association, 
Mexico Citv, Lecture "Interesting Dermatological and 
Pathological Sections." 

Ellis, Francis A.: Louisiana State Dermatological Meet- 
ing. Guest Lecturer on Dermal Pathology. 

Robinson, H. M., Jr.: Appointed chairman of the com- 
mittee on Public Medical Instruction for the Medical 
and Chirurgical Faculty of Maryland. 

Robinson, H. M., Jr.: Lecture to the Pennsylvania 
Academy of General Practice in Pittsburgh, Pa. "Mod- 
ern Treatment of Common Dermatoses." 

Robinson, H. M., Jr.: Atlantic Dermatologic Conference 
in New York City. Discussion of Cases of Fibrous 
Xanthoma, Erythema Multiforme, and Rcitcr's Syn- 
drome. 

Ellis, Francis A.: Adantic Dermatologic Conference in 
New^ York Citv. Discussion of Pathology and Cases 
Presented. 



DEPARTMENT OF MEDICINE 



67 



22. March 20, 1956 

23. April 8, 1956 

24. April 8, 1956 

25. April 8, 1956 

26. April 8, 1956 

27. May 17, 1956 

28. June 7, 1956 

29. June 9, 1956 . 

30. June 18, 1956 



31. June 30. 1956 

32. June 20, 1956 

33. September 7, 1956 

34. October 15-26, 1956 

35. October 30, 1956 

36. November 12, 1956 

37. November 12, 1956 



Robinson, II. M., Jr.: Maryland Academy of Medicine 
and Surgery. "Cutaneous Manifestation of Systemic 
Diseases." 

Robinson, H. M., Jr.: Tele\'ision broadcast on TV-MD. 
"Plastic Planning for the Removal of Acne Scars." 

Strahan, John F. : Television broadcast on TV-MD. 
"Plastic Phmning for the Removal of Acne Scars. " 

Zeligman, Israel: Tele\'ision broadcast on TV-MD. 
"Plastic Planning for the Removal of Acne Scars." 

Ellis, Francis A.: Southeastern Dermatological Confer- 
ence, Charlotte, N. C. Discussion of the Pathologv of 
the Cases Presented. 

Robinson, 11. M., Jr.: Lecture to the staff, St. Agnes 
Hospital, Baltimore, Md. "The Skin as a Diagnostic 
Site." 

Ellis, Francis A.: Elected to the Board of Directors of 
the Society of Investigative Dermatology. 

Robinson, R. C. V.: American Medical Association Con- 
vention, Chicago, III. Opening discussion, "Candida 
Albicans Infection of the Skin," by Drs. Wright and 
Sternberg. 

Robinson, H. M., Jr.: American Dermatologic Associa- 
tion, Santa Barbara, California, opening discussion of 
the paper "Cutaneous Papalomatosus," by Dr. Beatrice 
Kesten. Other paper discussed was "Undergraduate 
Education" by Dr. Donald Pillsbury. 

Ellis, Francis A.: Pacific Dermatological Association, 
Honolulu, Hawaii. Panel on Histopathologv. 

Robinson, R. C. V.: New Jersey Academy of General 
Practice, "Cutaneous Manifestations of Peripheral 
Vascular Disease." 

Robinson, H. M., Jr.: Television broadcast for the Balti- 
more CitN' Health Department. "Ri^^^^'v:^-!!!." 

Robinson, H. M., Jr.; Robinson, R. C. V., and Cohen, 
Morris M.: Exhibit, The New York Academv of 
Medicine, "Topical Steroid Therapv." 

Robinson, H. M., Jr.: "Antibiotic Combinations in 
Dermatology." Read before the panel on Antibiotics 
in Kalamazoo, Mich. 

Ellis, F. A. : A member on the panel on Dermal Path- 
ologv. Also opening discussion of Dr. Morris Wais- 
man's article on "Skin Tags." 

Robinson, II. M., Jr.: Exhibit, Southern Medical Asso- 
ciation. "Tranquilizers in Dermatologv." 



68 BULLETIN OF THE SCHOOL OF MEDICINE. U. OF AID. 

38. November 19, 1956 Robinson. II. M.. jr.: A member of the panel on Geri- 

atrics. Discussed before the American CTcriatric So- 
ciety, New York City. 

39. Decembers, 1956 Ellis. Francis A.: American Academ\ of Dermatology 

meeting, Chicago, 111. Consultant on the Panel on 
Clinical Pathological Problems. 

40. December 8, 1956 Robinson, H. M., Jr.; Robinson, R. C. V., and Strahan, 

]. F. : American Academy of Dermatology, Chicago, 
111. Exhibit, "Tranquilizers in Dermatology."' 

41. January 14. 1957 Ellis. Francis A.: Lecture on "Dyskeratoses " at the Brook 

Army Hospital, San Antonio, Texas. 

42. February 7, 1957 Ellis, Francis A.: Lecture on "Dyskeratoses" to the staff 

of Walter Reed Army Hospital. 

43. March 28, 1957 Robinson, H. M., Jr.: "Cutaneous Manifestations of 

Systemic Diseases. " Lecture to the Staff at W^ilter 
Reed Army Hospital. 

44. April 4, 1957 Robinson, H. M., Jr.: American Academy of General 

Practice Meeting, Harrisburg, Penna. Lecture on the 
"Management of Common Dermatological Condi- 
tions. ' 

45. April 11, 1957 Robinson, H. M., Jr., and Ellis, Francis A.: presented 

paper entitled "Cutis Laxa" before the American 
Dermatological Association Meeting in Bellaire, Fla. 

46. June 2. 1957 Ellis, Francis A.: A member of the Board of Directors 

of the Society of Inyestigatiye Dermatology. 

Exhibits 

1. iXoy. 6 to 10, 1955 Robinson, H. M., Jr.; Robinson, R. C. V., and Strahan, 

John F. : Southern Medical Association meeting. 
"Topical Steroid Therapy. '" Houston, Texas. 

2. Dec. 5 to 9, 1955 Robinson, H. M., Jr.; Robinson, R. C. V.; Strahan, John 

F.. and Cohen, Morris M.: American Academy of 
Dermatology and Syphilology, Chicago, 111. "Prepara- 
tions of Steroids for Topical Therap\. '" 

3. Mar. 3 to 6. 1956 Robinson, H. M., Jr.; Cohen, Morris M.; Robinson, R. 

C. v., and Bereston, Eugene S.: American Academy 
of General Practice meeting, Washington, D. C. 
"Simplified Office Mycology." 

4. Mar. 17 to 22, 1956 Robinson. H. M., Jr.; Cohen, Morris M.; Robinson. R. 

C. v., and Bereston, Eugene S.: Sesquicentennial 
Celebration at College Park, Maryland. "Simplified 
Office Mycology." 

5. June 10 to 14, 1956 Robinson, H. \L, Jr.; Robinson, R. C. V., and Strahan. 

John F.: American Medical Association, exhibit 
"Preparations of Steroids for Topical Therapy." 



DEPARTMENT OF MEDICINE 69 

6. Iliiic 10 lo 14, 1956 Bcreslon, Lugcnc S.: American Medical /Xssociation 

meeting, Chicago, 111. "Onychomycosis" (co-exhibitor 
with Dr. C'leveland White of Cliicago). 
Ci. Needs of the Division 

a. Space 

1 heie is an urgent need lor more examiin'ng rooms in the Out Patient De- 
jiartment. In visiiali/ing growth o\'er the next ten year period, we will prohahlv 
need at least doiihle our present s|xice. We dellnitelv need a laboratory lor 
research in patholog\' and chemistry. Space should also be allotted lor animal 
storage. Pro\isions must be made lor adecpiate space for the examination and 
treatment ol priyatc patients. 

b. I\'rs()inu'l 

/\t present we haye one part time secretary vyho is |)aid Irom grants-in aid 
and one lull time seeretar\' on the Llnixersity budget. I here is dehnite need lor 
another lull time medical secretary who may process routine reports and j^repare 
nianuscri|)ts and correspondence. 

We should ha\'e proyisions in the budget for both a resident and an assistant 
resident in dermatology. We ha\'e one lidhtime Fellow who is vyorking without 
salary. Funds should he allotted lor the pa\'ment ol such indixiduals. 

We ha\e one technician. 1 he expanding research program, in the yerv 
near lutine. makes the seryices ol another technician necessary. Funds should 
be made lor a technician grade number 2. 

c. Research liiiids 

At present we have an allotment of $600.00 a year from the department of 
medicine. In order to ])ro\'ide lor the purchase of animals and other expendable 
supplies, this shoidd be increased. 

d. Travel l-niids 

Funds should be axailable to defray the expenses of indi\iduals xyho are 
activeb' participating in national meetings. 

DIVISION' OF (.ASTROEN TFROLOC^Y 

A. Personnel: 

Ebeling, Wm. Carl, Ml) Assistant Professor of Medicine and 

Head of Division 

Schochat, /Mbert J., M.D Instructor in C gastroenterology 

and Staff 

B. Grants-in-aid- I9%-19S7: 
None. 

C. Curricidar Activities: 

Members of the division have participated in the teaching of introductory 
clinical sessions to the sophomore class, ward consultations with members of the 
junior and senior classes, endoscopic instruction to the house officers, and out-patient 



70 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

clinical supcr\ ision ot senior students. Lectures and seminars for the junior and 
senior classes ha\e been presented occasionally during the year. 

D. Research Activities: 

Dr. Ebeling is participating in salicxiatc absorption studies with the Department 
of Pharmacology. 

E. Piihlications: 

Ebeling, Wm. Carl and Little, Joan W.: The Demonstration of Malignant Cells Exfoliated 
from the Proximal Colon. Ann. Int. Med., 40, No. 1, January 1957. 

F. Educational Activities: 

November 14, 1956— Dr. Ebeling: "A Comparison of Exul and Exul Minus 
NUPRA in the Treatment of Duodenal Ulcer Disease, " First Annual Clinical 
Conference on Peptic Ulcer, New York, N. Y. 

April 20, 1957— Dr. Ebeling: "The Etiology of Peptic Ulcer," Symposium on 
Peptic Ulcer, Chattanooga Medicine Co., Chattanooga, Tenn. 

May 4, 1957— Dr. Ebeling: "Functional Evaluation of Liver Disease," Annual 
Medical and Surgical Symposium, Lutheran Hospital of Maryland, Inc., Baltimore, 
Md. ' 

May 17, 1957— Dr. Ebeling: Diagnosis of Diseases of the Pancreas," Annual 
Convention of Provident Hospital Former House Officers Association, Baltimore, 
Md. 

G. Needs of the Division: 

a. Space— this is dependent on the personnel available. 

b. Personnel— one Fellow (full time), one summer Fellow, and probably one tech- 
nician. 

DIVISION OF HYPERTENSION 

A. Personnel: 

Samuel T. R. Revell, Jr. . . . Head of Division and Associate Professor of Medicine 

Francis J. Borges Assistant Head of Division and Associate in Medicine 

George Entwisle Assistant Professor of Medicine 

Emidio A. Bianco Hyptertension Foundation Fellow in Medicine 

B. Grants-ln-Aid-1956-1957 

Anioiiiit Title 

Hypertension Foundation, Inc $8,000.00 Fellowship 

West Baltimore Kiwanis Club 500.00 Equipment 

Bressler Reserve Fund 4,200.00 Spectrophotofluorometei 

Maryland Heart Association 4,270.00^^ Research in Serotonin 

"Effective July 1, 1957 

C. Ciirricular Activities: 

Members of the Division have actively participated in the Teaching program 
of the Department of Medicine. Regular weekly rounds in problems of hypertension 
and renal disease have been conducted for the house staff, junior and senior students 
assigned to the medical wards, stressing meticulous etiologic diagnosis. An addi- 



DEPARTMENT OF MEDICINE 71 

tional weekly Hypertension Clinic, in the Out Patient Department, has been 
maintained. Here the senior students attend as an eJectixe. Members of the Dixision 
have participated in the Tuesday noon Medical Clinics and the Saturda\' seminars 
for junior and senior students, house staff and facult)'. 

D. Research Activities: 

1. Clinical research dealing with the pathogenesis of human hxpertension haye 
indicated that the occurrence of so-called "Essential Hypertension" is inversely 
proportional to the effort expended in search for some contributing disease, 
usually renal. 

2. Clinical studies in the etiology and pathogenesis of pyelonephritis, employing 
"Glitter" cell techniques. Gram strains of urinary sediment, simultaneous cul- 
tures of urinary bladder, both renal pelves and renal parenchyma obtained by 
needle biopsy have pointed out the difficulties in establishing a diagnosis of 
chronic pyelonephritis. These studies cast considerable doubt on the etiologic 
signiHcance of the common coliaerogenes group of organisms found in urine 
cultures. 

3. Techniques have been perfected so that permanent bilateral ureterostomy 
openings have been prepared in dogs which allow differential studies of renal 
function to be repeated for long periods of time. There is pending a grant-in-aid 
from the United States Public Health Service to study the etiology of pyelone- 
phritis and its possible role in the pathogenesis of hypertension. 

4. Metabolic studies on serotonin have shown that its metabolic end-product 
5-hydroxy indole acetic acid is reduced in the urine of patients with malignant 
hypertension and chronic glomerular nephritis. Studies are in progress to deter- 
mine if this reduced excretion of 5-hydroxy indole acetic acid in severe renal 
disease is the result of reduced amine oxidase activity in the diseased kidney 
or to a retention of serotonin in the blood. 

E. Ptihlications-]u\y 1, 1955 to June BO, 1957 

1. BoRGES, F. J.; Revell, S. T. R., Jr. and O'Malley, W. E.: Prolonged intrahepatic 
obstructive jaundice induced by para-aminobenzyl caffeine hydrochloride: An Experi- 
mental Antihypertensive Agent, ). Lab. & Clin. Med., 47: 735-742, 1956. 

2. BoRGES, F. J. and Bessman, S. P.: Urinary excretion of 5-hydroxyindole acetic acid, a 
serotonin metabolite, in hypertensive renal-vascular disease, Proc. Soc. Exper. Biol, and 
Med., 93: 513, 1956. 

3. BoRGEs, F. J. and Bessman, S. P.: Serotonin— an editorial, Ann. Int. Med., 46: 425, 1957. 

F. Educational Activities 

1. Medical Seminars— Provident Hospital, Baltimore, October 7 & 14th, 1955— 
"H\'pertcnsion, Diagnosis and Treatment." 

2. Medical Seminars— St. Agnes Hospital, Baltimore, Jan. 12th & 19th, 1956— 
"Hypertension, Diagnosis and Treatment." 

3. Medical Honorary Society, Annual Meeting, Mar. 1st, 1956— Discussion— 
"Serotonin." 

4. Delaware Academy of General Practice, Oct. 24th, 1956— "Pathogenesis, 
Diagnosis and Treatment of Hypertension." 



72 BULLETIS OF THE SCHOOL OF MEDICINE, U. OF MD. 

5. Medical Seminar— St. Agnes Hospital, Baltimore, Nov. 1st, 1956— "Patho- 
genesis, Diagnosis and Treatment of Chronic Pyelonephritis. 

6. St. Agnes Hospital Staff— "Serotonin, Its Clinical Implications." Nov. 1956. 

7. Mar\land Academv of Cieneral Practice— Dec. 13th, 1956— "Hypertension, 
Diagnosis and Treatment." 

8. LIni\ersitv Hospital Staff" Meeting— Jan. 17th, 1957— "Current Problems Re- 
lating to Serotonin." 

9. Franklin Square Medical Staff Meeting— Jan. 24th, 1957— "Serotonin." 

10. Medical Staff Meeting, Marvland General Hospital, Mar. 12th, 1957— "Sero- 
tonin." 

11. Medical Seminar Mercv Hospital, Baltimore, Mar. 26th, 1957— "Treatment of 
Hypertension." 

G. Needs of the Division 

1. Space 

a. Urgentlv needed is space for additional 10 dog cages in the animal farm. 

b. Badlv needed is space for animal experimental work. \^^e are at present 
using the facilities of experimental surgerv which are alreadv taxed to 
utmost. The space will be inadequate to perform serial differential renal 
functions and the experimental surgerv. Minimal space for these would be 
200 sq. feet. 

2. Personnel 

One Fellow and one technician are paid from funds from grants-in-aid. The 
division has one half-time secretarv. It is requested that funds be provided for 
a full-time secretarv and half-time laborator\' helper. 

SECTION OF INFECTIOUS DISEASES 

A. Personnel 

Parker, Robert T., M.D Director, Section of Infectious Diseases 

Snyder, Merrill J., Ph.D Assistant Professor of Medicine in 

Clinical Microbiolog\' 

McCrumb, Fred R., Jr., M.D Associate in Medicine 

Raffel, Norma K., Ph.D Assistant in Clinical Bacteriologv 

Togo, Yasushi, M.D Fellow in Medicine 

Blank, Eugene, M.D Wveth Fellow in Medicine 

Merideth, Ann M., M.S Bacteriologist, Laboratorv Technician I 

B. Grcints-ln-Aid-l956-l957 

Source Amount Title 

Parke, Da\'is and Company $10,000.00 Antimicrobial Research 

Commission on Immunization, 

Armed Forces Epidemiologic Board. . 19,000.00 Field Studies on Immunization 

and Related Problems 
Wyeth and Company 5,000.00 Wveth Fellowship 



DEPARTME><T OF AIEDICLXE 73 

C. Citrricidar Activities 

Members of the Section have participated in the teaching of microbiology to the 
sophomore class. Regular weekly rounds in problems of infectious diseases ha\'e 
been given to senior students and house staff on the medical wards. Additional 
weekly sessions pertaining to specific infectious disease problems have been pre- 
sented to senior house officers. Lectures and seminars for junior and senior classes 
and facultv' have been presented at the Tuesdav noon clinics and Saturdav seminars. 

D. Research Activities 

1. Clinical and laboratory appraisal of antimicrobial drugs, particularly chloram- 
phenicol, has been continued. 

2. Studies pertaining to the arthropod-borne viruses, initiated in Malava with the 
U. S. Army Medical Research Unit, have been continued and extended in 
Baltimore. Viral agents, capable of causing fevers of short duration in man 
have been isolated in suckling mice. One virus strain has been shown to repro- 
duce the clinical manifestations characteristic of dengue. In addition to the 
agents derived from human sources, eight viruses isolated from wild caught 
mosquitoes are under study. The interrelationships which exist among these 
agents, as well as those of African and South American origin, are being in\"esti- 
gated by cross-neutralization and cross-complement-fixation tests. Finally, at- 
tempts are being made to relate the Malayan prototype viruses to human disease 
by serologic testing of serum specimens collected from man in Malava during 
the course of febrile illnesses. 

A comprehensive study of the behavior of arthropod-borne viruses in tissue- 
culture has been initiated. The application of tissue-culture techniques to viral 
isolation and serodiagnostic procedures is being stressed. 

3. The pathogenesis and chemotherapy of tularemic infections is under studv. 
The varying patterns of immunity in relation to specific therapy with anti- 
biotics have been appraised in mice and guinea pigs. Intermittent therapeutic 
regimens provide better therapeutic results. Volunteers have been infected bv 
the intradermal route and shown to develop manifestations of mild tularemia. 
It has been observed that streptomycin, when administered sexeral hours after 
inoculation, eradicates the infection and clinical disease. The serologic response 
is also inhibited. Chloramphenicol, so employed, suppresses the infection and, 
on cessation of administration, active manifestations of illness and antibody 
response ensue. Host factors relating to pathogenesis and response to chemo- 
therapy are under study. This work was presented at the annual meeting of the 
Association of American Physicians in Atlantic City in May, 1957. 

4. Tissue-culture techniques have been developed and various lines of cells 
established. Polio virus and other enteric agents, causative in aseptic meningitis, 
have been isolated and are being characterized bv these techniques. 

5. Eastern equine encephalitis virus was isolated for the first time in Maryland 
from the brain of a fatal human case from Salisbury, Maryland, in the summer 
of 1956. Field studies including a serologic survey of bovine and human hosts 
within the State of Maryland are under studv. 



74 BUI IET1>^ OF THE SCHOOL Of MEDICINE. U. ()/ MD. 

E. PuhIicatUws-]u\\ 1, 1^)SS junc.^0. 1957 

McCrumb, F. p., Jr.; Mercier, S.; Chen, V. 11.: Mi vi u. K. I . aiul C.oodner. K.: Studies 

on the antibodv patterns in pneumonic plague |1ati^.'lU^. |. liil. Dis.. yf»: 88*^)4, 1^)SS. 
Parker. Robert T.: True Significance and Real Incidence ol Reactions 1 iill(i\\iiii> C'linic.il 

Use of Antibiotics, Antibiotics Annu.d. i'^)SS S6. Medical l'iic\cln|Hili.i, Inc., i\c\\ VoiL, 

N. Y., 967 982, 1955. 
McCrumb, F. R., Jr.; Stockaro, Joe L. and W'oonwAiin. 1 . !£.: Leptospirosis as a inajor 

cause of short term pyrexia in a tropical enxironinent. 1 rans. Asso. Am. Physicians, 69: 

122, 1956. 
McCrumb, Frei> R., Jh.: 1 ulareml.i in 11. Conn. Current llur.qn, l'-)'i7, Saunders; Phila- 
delphia, 1956. 
Parker, Robert T.: Rocky Mountain spotted lever. Current 1 lur.ipv. \'-1>(-<. 
Parker, Robert T.: Associate Editor oH Section on JAickettsial liiiections and .uuiior of 

Chapter on Rocky Mountain Spotted Fc\er in Meakins Practice of Medicine. Text. 

Meakins, J. C: Practice of Medicine, 6th Hd. C. V. Mosby, St. Louis, 1956. 
Parker, Robert T.: Rocky Mountain spotted leyer. Current Therapy, 1957. 
McCrumb, F. R., Jr.; Stockard, Joe L.; Robinson, Charles R.; Turner, Leslie H.; 

Levis, Derrick L.; Kelleuer, ]\L P.; Cleiser, Chester A. and Smauel, Joseph E.: 

Leptospirosis in Malaya. L Sporadic cases among military and civilian personnel. Am. J. 

Trop. Med. Hyg., in press. 
Alexander, A. D.; Evans, L. B.; Toussaint, A. J.; Marchwu ki, R. 11. aiui MtC'iuiMn. 

F. R., Jr.: Lepti)spirosis in Malaya. IL Antigenic analysis oi 1 lO leptospind str.iins ami 

other serologic studies. Am. J. Trop. Med. Hyg., in press. 
McCrumb, F. R., Jr.: Epidomiologic and public health aspects leptospirosis. \'eterinar\' 

Aledicine, in press. 
McCrumb, F. R., Jr.; Snyder, M. J. and Woodward, T. II.: Stutiies on luimin injection 

with PasteitrcJhi tiiUtrensis. 1. Comparison of streptomycin and chloramphenicol in the 

prophylaxis of clinical disease. Trans. Assoc. Am. Physicians, in press. 

F. Ediicatiuiial Activitics-]u\\ 1, 1955 June .^0, 1957 

November 2, 3 R. 1 . Parker Thiid /\nnual Symposium on /\iitihi 

and 4, 1955 otics, VVashinoton, D. C. 

January 18, 1956 M. J. Snyder Maryland Society of Medical Technolo- 

oists "Ccrebros|)inal 1 luid" 

March 1. 1956 R. \. Parker I louse Stall' Conlerenee, St. Agnes I los- 

pital, Baltimore, Maryland. "Manage- 
ment of Purulent Meningitides." 

March 1 and 2, M. J. Snvdcr New Academy of Science, New York 

1956 City Conference on Natural Resist- 

ance to Infection. 

April ?). 1956 P. R. McCrumh, Jr. Commission on Imminii/ation— Armed 

Porces Ppidemiological Board, Wash- 
ington, 1). C. 

April 28- M.J. Smcler /\nnual Meeting, Society of American 

Ma\' 4, 1956 Baeteriolooists, I louston, Texas 

October 23, 1956 R. P. Parker Lecture at Church I loine and Hospital, 

Baltimore, Maryland 

October 25-27, P. R. McCrumb, Jr. Plenty Pord Hospital — International 

1956 1 lepatiiis S\ inposium, Detroit, Michi- 

oan 



DEPAHTMENT OF MEDICINE 



75 



November 21, 1956 [•. R. McOumh, Jr. 



November 13, 14, 1 . R. McCrumb, Jr. 
and 23, 1956 



December 20, 1956 M. J. Snvder 



December, 1956 F. R. McCrumb, Jr. 
and 
N. K. Raflcl 
January 4 and 5, M. J. Snvder 
1957 

January 12, 1957 F. R. McCrumb, Jr. 



January 16, 1957 M. J. Snyder 



January, 1957 F. R. McCrumb, Jr. 

January 14-15, F. R. McCrumb, Jr. 

1957 

February 26, 1957 M. J. Snyder 



March 19, 1957 
March 21, 1957 

March 23, 1957 
March 27, 1957 



F. R. McCrumb, Jr. 

r. R. McCrumb, Jr. 

and 
N. K. Raffel 
F. R. McCrumb, Jr. 

M. J. Sn\der 



March 30, 1957 F. R. McCrumb, Jr. 



Post (rradiiatc Seminar — "Recent Ad- 
Nances in Infectious Diseases," Wil- 
mington, Delaware 

Walter Reed /\rm\ Institute ol i\esearch 
—Medical Refresher Course, Wash- 
ington, D. C. Antibiotics— November 
13; Meningitis, November 14; Plague, 
November 23 

Medical Staff, St. Agnes Hospital, Balti- 
more, Maryland. "Encephalitis— Lab- 
oratory Aspects." 

Maryland General Hospital, Baltimore, 
Marvland. "Tissue Culture." 

New York Academy of Science, New 
York Citv. Conference on Immun- 
ology and Cancer. 

American College of Physicians, Re- 
gional Meeting. "Eastern Ecjuine En- 
cephalitis in Marvland," Washington, 
D. C 

Peninsula General Hosj^ital. Salisbury, 
Maryland. "Encephalitis — Laboratory 
Aspects." 

Baltimore City Hospitals. Baltimore, 
Maryland. "Aseptic Meningitis." 

Civil Defense Laborator\ Resources Pro- 
gram, Adanta, Georgia 

Medical Staff, Maryland General Hos- 
pital, Baltimore, Maryland. "Ence- 
phalitis—Laboratory Aspects." 

Mar\'land General Hospital, Baltimore, 
Maryland. "Subacute Endocarditis. ' 

St. Agnes Hospital, Baltimore, Mary- 
land. "Tissue Culture." 

Ci\'il Defense Laboratory Resources Pro- 
gram. Washington, D. C. 

Post Graduate Basic Science Course. 
"Natural and Immune Mechanisms of 
I lost Resistance." 

Commission on Rickettsial Diseases- 
Armed Forces Epidemiological Board, 
Washington, D. C. 



nuiLKTi:^ OF THE school of medicine, u. of aid. 

April In, 1957 F. R. McCruml), Jr. Commission on Immunization— Armed 

Forces Epidemiological }3oard, Wash- 
ington, D. C. 

April 1 1, 1957 R. T. Parker House Staff Conference, Church Home 

and Hospital, Baltimore, Maryland 

April 18. 1957 R. T. Parker House Staff Conference, Church Home 

and tlospital, Baltimore, Maryland 

April 25. 1957 R. T. Parker House Staff Conference, Church Home 

and Hospital, Baltimore, Maryland 

April 25, 1957 F. R. McCrumb, Jr. Kansas University Postgraduate Series— 

Leptospirosis Symposium, Kansas City, 
Kansas 

April 28- F. R. McCrumb, Jr. Annual Meeting, Society of American 

May 2, 1957 and Bacteriologists, Detroit, Michigan 

M. J. Snyder 

May 7, 1957 F. R. McCrumb, Jr. Association of American Physicians, At- 

and lantic City, New Jersey. "Chemopro- 

M. J. Snyder phylaxis of Tularemia." 

May 13-15, 1957 F. R. McCrumb, Jr. Civil Defense Laboratory Resources Pro- 
gram—Laboratory Sur\'ey: Raleigh, 
North Carolina, Durham, North Caro- 
lina, and Chapel Hill, North Carolina. 

May 16 and 17, M. J. Snyder Civil Defense Laboratory Resources Pro- 

1957 gram— Laboratory Survey: Columbia, 

South Carolina and Charleston, South 
Carolina. 

May 23, 1957 M. J. Snyder Upper Eastern Shore Medical Society, 

Chestertown, Maryland. "Recent Ad- 
vances in the Diagnosis of Infectious 
Diseases." 

May 28, 1957 M. J. Snyder Civil Defense Laboratory Resources Pro- 

gram—Laboratory Sur\'ey: Richmond, 
Virginia. 

May, 1957 F. R. McCrumb, Jr. Civil Defense Laboratory Resources Pro- 

gram—Laboratory Survey: Charlottes- 
ville, Virginia and Blacksburg, Vir- 
ginia. 

Needs of the Section 

a. Space— A small laboratory for processing tissue specimens on the medical floor 
of the hospital is desirable but not needed urgently. 

b. Personnel— Two technicians, one fellow (full-time), one summer fellow, one 
dicner and one associate (full-time) are funded from grants-in-aid. The Section 
has one secretary. A request is made for an additional senior stenographer to 
assist in the augmented responsibilities of the Section including the processing 



;)z?/.:.t;:e\t of medicine 77 

of routine reports, correspondence, preparation ot manuscripts, etc. This secre- 
tary will serve the other research laboratory sections of the 5 th Floor Bressler, 
particularK' in recording laboratory results and preparing manuscripts for 
publication, 
c. Research Funds— ¥unds of Si, 500.00 per year are needed to provide for small 
animal needs and other expendable supplies including requirements for dry ice. 

DIVISION OF NEUROLOGY 

A. Personnel: Title and Faculty Appointment 

Charles Van Buskirk, B.A., M.S., Ph.D., M.D. . Prof, of Neurologx' and Head, Div. 

of Neurology 
Jerome K. Merlis, B.S., M.S., M.D Prof, of Clinical Neurophysiology, 

Head, Dept. of Neurophysiology 

Harry A. Teitelbaum, B.S., M.D., Ph.D Assistant Professor of Neurology 

Philip F. Lerner, A.B., M.D Assistant Professor of Neurology 

George G. Merrill, A.B., M.D Assistant Professor of Neurology 

William L. Fearing, M.D Associate in Neurology 

Edward F. Cotter, M.D Associate in Neurology 

Luis R. Lombardo, ^LD Associate in Neurology 

Motoji Miyazaki, M.D Fellow in Neurolog) 

B. Grants-in-Aid: 

Donor Amount Title 

U. S. Public Health Service. .531,308 Graduate Training Grant in Neurology 
U. S. Public Health Service. . 15,354 Cooperati\'e Study of the Effectiveness of 

1-Asparagine in Control of Seizures 
LI. S. Public Health Service. . 13,869 Relation of Spinal Cord Circulation to 

Clinical Syndromes of Spinal Cord 

Disease 

C. Curricidar Activities: 

Members of the Di\ision of Neurology participate in teaching Sophomores, 
Juniors, and Seniors. During the Sophomore year they are responsible for presen- 
tation of the course Neurologic Diagnosis, a series of lectures and demonstrations 
presented weekly during the second semester. /\dditionall\\ thev participate in the 
course on Physical Diagnosis. During the Junior year a series of 14 lectures on 
neurologic diseases is gi\en. Other Junior teaching includes weekly ward rounds 
in the University Hospital, weekly conferences in the City Hospitals, and bi-weekly 
clinical-pathologic correlation conferences at the University Hospital. During the 
Senior year weekly conferences are held at the Unixersitv Hospital and there is 
teaching of Seniors in the Neurology Out-Patient Department each week. 

Additional activities include bi-weekly conferences held at Montebello Hospital 
during the school \'ear for those students assigned there. During the summer weekly 
conferences are held at Montebello for the summer clerks. 

Each week the Division of Neurology participates with the Division of Neuro- 
surgery in a neuroradiology conference with the Department of Radiology, a 



78 BULLETINS OF THE SCHOOL OF MEDICINE, U. OF AID. 

ncuropath()log\ conference with the Department ot Pathology and an EEC con- 
ference w ith the EEG Department. I hese conferences are for students and hospital 
staff. 

There are bi-monthK' combined neurology, neurosurgery conferences held in 
conjunction with the same departments of the Johns I lopkins Hospital, also for 
students and hospital staff. 

This \ear Dr. Merlis has instituted a course in Medical Electronics for the 
Medical School Staff. 

D. Research Activities: 

1. The Di\'ision of Neurology in conjunction with the Department of Pediatrics 
has continued with the project concerned with the clinical assessment of 
asparagine in the treatment of con\'ulsi\'e disorders. This project has developed 
into a consideration of several different aspects of this problem. 

a. A studv of the toxic effects of this drug in certain individuals indicates that 
acute ammonia intoxication mav arise. 

b. A study of the fate of orally ingested asparagine in normal individuals indi- 
cates that it is very rapidly transformed into glutamine. 

c. Clinical studies indicate that this drug has limited usefulness as an anti- 
convulsant but that it is most useful in individuals exhibiting myoclonic 
seizures or those with severe brain damage. 

2. Members of the Di\'ision are continuing genetic studies of certain hereditary 
neurologic disorders. 

3. Studv of transaminase activitv in serum and spinal fluid in normal patients and 
individuals with neurologic disorders has continued over the past year. More 
recentlv this studv has been extended to central ner\'ous svstem tissue. These 
studies indicate, among other things, that: 

a. Transaminase does not cross the blood-brain barrier. 

b. CSF transaminase may be increased bv acute destructive central nervous 
svstem lesions. 

c. CSF transaminase mav be increased in certain altered phvsiologic states such 
as con\'ulsions and hvdrocephalus. 

4. A studv of spinal cord circulation has been instituted. This project is at present 
concerned with innervation of spinal cord blood vessels. 

5. In the Demvelinating Disease Clinic, clinical assessment of the low-fat diet in 
treatment is in progress. 

E. Publications CJu]y 1, 1955-July 1, 1957): 

Lerner, p.: Kemadrin, A new drug for treatment of Parkinsonian disease. The J. of Nerv. 

and Ment. Dis., Vol. 123, No. 1, Jan., 1956. 
LoMBARDO, L. R.: Cerebellar ataxia, progressive external ophthalmoplegis, and cataracts, J. 

Neurol., 1957 (to be published). 
Merlis, J. K.; Forbes, A. et. al.: Measurement of the depth of barbiturate narcosis, EEG 

Clin. Neurophysiol., 8: 541, 1956. 
Merlis, J. K. and Lombroso, C: Suprasylvian auditory responses in the cat, EEG Clin. 

Neurophysiol., 9: — , 1957 (May issue). 



DEPARTMEIST OF MEDICINE 79 

Merrill, G. G.: The essence of counselling, Pastoral Psychology, Oct., 1956. 

Merrill, G. G.: Emotional disorders of later life: A review of pathogenesis and treatment of 

100 cases. Md. State Med. J. (to be published June 1957). 
Merrill, G. G.: Electroshock therapy in a general hospital. Md. State Med. J. (to be 

published). 
Merrill, G. G.; Prevention of postpartum psychosis. So. Med. J. (to be published). 
Merrill, G. G. and Cook, E. E.; The EEC in the negro: A comparison of electrical activity 

of the brain in white and negro patients. EEG Clin. Neurophysiol. (to be published). 
MiYAZAKi, M.: Comparative serum and cerebrospinal Huid transaminase levels in acute cerebro- 
vascular disorders. }3ull. Sch. Med., Univ. of Md., April, 1957. 
Teitelbaum, H. a.: ACTH and cortiscme therapy in the Guillain-Barre syndrome. Sinai 

Hosp. J., 5: 17-20, 1956. 
Teitelbaum, H. A. and Gantt, W. H.: The effect of starvation on sperm count and sexual 

reflexes. Science, 124: 363-364, 1956. 
Teitelbaum, H. A.: Homeostasis and personality. A.M. A. Arch. Neurol. & Psychiat., 76: 

317-324, 1956. 
Chang, M. C; Schaeffer, D.; Teitelbaum, H. A. and Gantt, W. H.: Does starvation 

increase sperm count? Science, 124: 203-204, 1956. 
Van Buskirk, C. and Callaway, E., Ill; Observations on vibratory thresholds, Confin. 

Neurol., 16: No. 6, 301-308, 1956. 
Van Buskirk, C: Carotid artery thrombosis (editorial). Annals of Int. Med., 45, No. 5, 

Nov., 1956. 

Lectures: 

Sept. 12, 1955 Teitelbaum, H. A., Zierler, K. L., Goldstone, H. and Nachlas. 

J. W. Panel discussion on muscular dystrophies and atrophies, 

Sinai Hospital, Baltimore. 
Sept., 1955 Merrill, G. G. Lecture to Lutheran Ministers Convocation, Balti- 

more. 
Nov., 1955 Merrill, G. G. Institute of Psychiatric Treatment, Boston State 

Hospital, Boston, Mass. 
Dec, 1955 Merrill, G. G. Lecture to University of Maryland Law School, 

"Injuries to Brain and Spine." 
Dec. 8, 1955 Van Buskirk, C. Post-Graduate seminar, Marvland Academv of 

General Practice, Sch. of Med., Univ. of Md., Baltimore. 
Dec. 11, 1955 Van Buskirk, C. Television Program (WBAL-TV), Baltimore, 

"Strokes." 
Jan. 3-4, 1956 Van Buskirk, C. Glinical Conferences and Neurology Rounds, 

University Hospital, Oklahoma City, Okla. 
Jan. 8, 1956 Lcrner, P. Beth Jacob Synagogue, "Religion and Psychiatry." 

Baltimore. 
Jan., 1956 Merrill, G. G. Address to Rabbinical Assn., "Psychiatry and Re- 

ligion." Baltimore. 
Feb. 1, 1956 Van Buskirk, C. Clinical Pathological Conference. U. S. Public 

Health Service Hospital, Baltimore. 
Feb. 17. 1956 Lerner, P. Doctors Hospital, "Parkinsonism.' Baltimore, (with 

him) 
Feb. 19, 1956 Lerner, P. Shaarei Tfiloh, "Community Aid in Treatment of 

Mental Disease. " 



80 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

March, 1956 Merrill. G. C. Geo. Washington LIniv., Seminar on Geriatrics. 
W^ashington, D. C. 

March 11. 1956 Merrill. G. C Alpha Phi Fraternity. "Teenager and Sex." Balti- 
more. 

March 12. 1956 Lerner, P. Joseph Le\v Chap. Deborah Lodge, "Communit\ Aid 
in Treatment of Mental Disease." Baltimore. 

March 17, 1956 Van Buskirk, C. Television Program, Sheraton Park Hotel, Wash- 
ington, D. C. "Multiple Sclerosis." 

March 21, 1956 \'an Buskirk, C. Univ. of Maryland, Post-Graduate Seminar 
"Neurological Aspects of Lupus Ervthematosis." Baltimore. 

April, 1956 Lombardo, L. R. Residents Annual Meeting, Wilmer Inst., Johns 

Hopkins Hospital, Clinical presentation. Baltimore. 

April 7. 1956 \'an Buskirk, C. Xorth X'irginia Assembly, Alexandria. Va. 
"Chronic Brain Svndrome." 

April 23, 1956 Teitelbaum. H. A. Sch. of Med., Univ. of Md., Sophomore 
Class, Psvchosomatic processes in personalitv disturbance asso- 
ciated with organic disease." Baltimore. 

^Ln• 10. 1956 Lombardo. L. R. St. Agnes Hosp. Conference, "Cerebrovascular 
Disease." Baltimore. 

Ma\ 10, 1956 Teitelbaum, H. A. Pa\lo\ian Soc. Meeting. Ithaca, X. Y. Round 
Table on condition reflexes in psvchotherapv. 

June, 1956 Merrill, G. G. Lecture to Mental DeHciencv Assoc, Trenton. X. J. 

"Mental Deficiencv Problems." 

June. 1956 Lombardo, L. R. House Stafi^. Salisburv Gen. Hosp., Salisburv, 

Md. "Aseptic Meningitis." 

June 1-2, 1956 Teitelbaum, H. A. Am. Psvchopathological Soc. Meeting, X. Y. C. 
"Defensi\e verbal communication processes in psvchotherapv." 

Sept. 8, 1956 Van Buskirk, C. Tele\ision program (VVMAR-TV), "Multiple 
Sclerosis." Baltimore. 

Sept., 1956 Lerner, P. Mercv Hosp. Seminar. "Acute and Emergencv X^eur- 

ologv and Psvchiatrv Problems." Baltimore. 

Sept. 17. 1956 Lerner, P. Phi Lambda Kappa Med. Fraternity, "Welcoming Ad- 
dress," Freshman Class, Sch. of Med.. Univ. of Md., Baltimore. 

Sept., 1956 Merrill, G. G. Institute of Ps\chiatric Treatment, Boston State 

Hosp., Boston, Mass. 

Oct. 21. 1956 Van Buskirk, C. Telex ision Program (WBAL-TV), "Encephal- 
itis." Baltimore. 

Oct. 31. 1956 Van Buskirk, C. Delaware Acad, of Gen. Practice, "Diagnosis and 
Management of Cerebro-\ascular diseases." W'ilmington, Del. 

Oct. 31. 1956 Cotter, E. F. Del. Acad, of Gen. Prac. "Demvelinating Diseases." 
Wilmington. 

Oct. 31. 1956 Lombardo, L. R. Del. Acad, of Gen. Prac. "Muscular and De- 
generative Diseases of the Motor Xeuron." Wilmington, Del. 

Oct.. 1956- Merrill, G. G. Monthly lectures, St. Mary's Church, Hampden, 

Ma\. 1957 "Mental Health and Religion." 



DEPARTMENT OF MEDICINE 81 

Nov. 13, 1956 Teitelbaum, H. A. David J. Macht, So. Medical Assn., Discussion 

of "Pharmacology, of Blood and Urine of Psychotic Patients 

before and after Drug Therapy." Washington, D. C. 
Nov. 29, 1956 Van Buskirk, C. Medical Rounds, Franklin Square Hospital, 

"Cerebellar Ataxia." Baltimore. 
Dec, 1956 Merrill, G. G. Address to Maryland Soc. for Clin, and Experim. 

Hypnosis. "Sexual Complications of Hypnosis." Baltimore. 
Dec. 13, 1956 Van Buskirk, C. Discussion of paper by Weinstein, "Symbolic 

Organization fter Brain Injury." (Neurol. & Ps\chiat. Sec.) 

Med. & Chir. Soc. Baltimore. 
Dec. 23, 1956 Lerner, P. Mercantile Club, "Psvchiatr\ and Religion." Baltimore 
Dec, 1956 Merlis, ]. K. Discussion of paper bv E. Weinstein, "Effects of 

Diffuse Brain Injury," Ross Symposium. Baltimore. 
Dec, 1956 Merlis, J. K. Discussion of Symposium on "Prognostic Value of 

EEC in Epilepsy." Am. League Against Epilepsy Meeting, 

N. Y. C. ' 

Dec, 1956 & Lombardo, L. R. Six lectures on Basic Neurology. Crownsville 

(Jan. 1957) State Hospital, Crou'nsville, Md. 
Dec. 20, 1956 Lombardo, L. R. House Staff, St. Agnes Hosp. "Encephalitis." 

Baltimore. 
Jan. 8 (& 22— Teitelbaum, H. A. Psxchosomatic Conferences, Johns Hopkins 
also Feb. 19, Hospital, "Homeostatic & Neurologic Integration in Personality 
1957 Structure." Baltimore. 

Jan., 1957 Merrill, G. G. Address to Presbyterian Church School Teachers, 

"Mental Health in Teaching." Baltimore. 
Jan. 14, 1957 Lerner, P. P.T.A. Beth Jacob Synagogue and Center, Panel Dis- 
cussion: "Do Religious Educational Needs Produce Conflict in 

the Child?" Baltimore. 
Jan. 15, 1957 Van Buskirk, C. Mercy Hosp. Medical Staff, "Treatment of Cere- 

bro\'ascular Accidents." Baltimore. 
Jan. 17, 1957 Van Buskirk, C. Franklin Square Hosp., Medical Staff". "Cerxical 

Abscess." Baltimore. 
Jan. 24, 1957 Van Buskirk, C. St. Agnes Hospital, House Staff. "Multiple 

Sclerosis." Baltimore. 
Feb., 1957 Merlis, J. K. Maryland Anesthesia Soc, "Electroencephalography," 

Baltimore. 
Feb. 3, 1957 Lerner, P. Har Sinai Brotherhood, "Psxchosomatic Disease; in the 

Book of Proverbs and Book of Songs." Baltimore. 
Feb. 4, 1957 Lerner, P. Maryland Assn. for Mental Health, Annual Meeting, 

Annapolis, Md., "The Case for the Mental HosjMtals." 
Feb. 14, 1957 Cotter, E. F. St. Agnes Hosp., "Coma, Its Pathogenesis & Treat- 
ment." Baltimore. 
Feb. 28, 1957 Teitelbaum, H. A. Sinai Hosj-)., "Psychosomatic aspects of cerebral 

vascular disease." Baltimore. 



82 BULLETir^ OF THE SCHOOL OF MEDICINE, IJ. OF MD. 

Marcli, 1957 Lerner, P. Citizens Committee for Aid to Maryland State Mental 
Hospitals, "Someone who Cares— the Need for Volunteer Work- 
ers in Treatment of Mentally HI" Baltimore. 

Apr. 25, 1957 Van Buskirk, C. Chairman. Scientific Session, Am. Academy of 
Neurology. Boston, Mass. 

Apr. 27, 1957 Lombardo, L. R. American Academy of Neurology Meeting, 
reading of paper, "Cerebellar Ataxia, Progressive External 
Ophthalmoplegia and Cataracts." (paper to be published.) 

/\pr. 27. 28, Van Buskirk, C. Conference on Graduate Educ. in Neurology, 
29, 1957 Chairman of discussion panel. Boston, Mass. 

Max, 1957 Merlis, J. K. Mercv Hosp. Staff Seminar, "Diagnosis of Epilepsy." 

Baltimore. 

Ma\ 21, 1957 Lerner, P. Citizens Comm. for Aid to Maryland State Mental 
Hospitals, "Our Mental Hospitals." Baltimore. 

May 28, 1957 Teitelbaum, H. A. Maryland Assn. Private Practicing Psychia- 
trists, "Psychosomatic Aspects of Disturbances in Vision." Balto. 

G. Needs of the Dixnsion: 

a. Space: There is an urgent need for office space for present full time personnel. 
Additionally, the small laboratory area assigned to neurology this past year is 
already crowded and within the coming year will be too small. 

b. Personnel: At present the Division of Neurology supports through grants-in- 
aid, two summer Fellows, increasing to four this coming vear, one-half a secre- 
tary, two-thirds of a full-time associate, one student research assistant, one 
technician and one part-time EEC technician. In regards to personnel, the 
division needs increasing University support for two faculty members. 

c. Summary of Needs: The Division of Neurology over the past three years has 
enjoyed for the first time full-time faculty members. This factor has resulted in 
an increase in the activities of the division and, consequently, an increase in its 
needs. It is apparent that this division, along with the rest of the Medical School 
and Hospital will continue to grow for a while. There will be increasing service 
and teaching activities which can be accomplished with the present personnel 
only at the expense of research activities. The immediate most urgent needs are 
increasing Uni\'ersitv support for faculty members, namely an instructor and 
an associate, and offices and laboratory space for these people. 

Although research funds are quite adequate for the needs of the division at 
present, these are obtained from an outside source. Such sources, of necessity, 
delay and restrict activity in this area. A moderate annual University grant of 
$1,200 to $1,500 to the Division for research purposes would produce con- 
siderable elasticity in the research program. 



DEPARTMENT OF MEDICINE 



83 



OLIT-PATIENT DEPARTMENT 
A. Personnel 

George Entwisle, M.D., Assistant Professor of Medicine 

Director of Medical Clinic 
Joseph C. Furnari, M.D., Associate in Medicine 
Assistant Director of Medical Clinic 



Attending Physicians in 
Joseph Bronushas, M.D. 
Leon Kassel, M.D. 
John Legge, M.D. 
William Esmond, M.D. 
Morton Krieger, M.D. 
Donald Mintzer, M.D. 
Louis Blum, M.D. 
Stephen Van Lill, M.D. 
Jonas Cohen, M.D. 
Stanley Steinbach, M.D 
Seymour Rubin, M.D. 
Walter Karfgin, M.D. 
John DeHoff, M.D. 



Medical Clinic 

Charles Williams, M.D. 

Kurt Levy, M.D. 

Joseph Matchar, M.D. 

Joseph Shear, M.D. 

A. A. Silver, M.D. 

Conrad Acton, M.D. 

Joseph Muse, M.D. 

Paul Bverlv, M.D. 

William Helfrich, M.D. 
. W. Kennedv Waller, M.D. 

William F. Cox, M.D. 

Sheldon Greisman, M.D. 



Frank Kuehn, M.D. 
Sherwood Miller, M.D. 
Robert Bauer, M.D. 
John Stauffer, M.D. 
Charles Wisseman, M.D. 
Lewis P. Gundry, M.D. 
John Strahan, M.D. 
Kyle Swisher, M.D. 
Leonard Scherlis, M.D. 
Carroll Spurling, M.D. 
Frank Borges, M.D. 
James Karns, M.D. 



B. Grants-ln-Aid- 
None. 



■1956-1957 



C. Currictdar Activities 

Each member of the Senior Class spends four weeks in the Medical Clinic of 
the Outpatient Department. The student spends half his dav in the general medical 
clinic and the other half of his dav rotating through one of the Medical Sub- 
specialty Clinics. A weekly session is held with students who report to their class- 
mates on various subjects thev have studied. 

The Home Visit Program was enlarged in the Fall of 1956. Senior students 
follow the patients at home under the immediate supervision of the General 
Practice Resident. Most of the patients seen under this program had acute temporary 
illnesses. 

D. Research Activities 
None. 

E. Pnhlicatiofis 

Fuller, H. L. and Kassel, L. E.: Metamine (triethanolamine trinitrate biphosphate) in 

angina pectoria, J. A. M. A., 159, No. 18, 1708-1713, 1955. 
Entwisle, G. : The cardiac arrhythmias; some aspects of treatment. The Med. Clin, of 

N. Amer., 39, 1367-1379, 1955. 
Hollander, W. and Entwisle, G.: Transient ventricular tachycardia following the Valsalva 

maneuver in a patient with paroxysmal atrial tachycardia. Amer. Heart J., 52, 799-803, 

November, 1956. 
Entwisle, G. and Hale, E: Hemodynamic alterations in hemorrhagic fever. Circulation 15, 

414-425, 1957. 



84 HlininiN OF THE SCUOQ], OF MEDJCZNE, L/.-OF MD. 

Silver. A. A. and Zeligman, I.: Necrobiosis lipoidica diabeticorum controlled equally by 

insulin and tolbutamide (orinase) Sinai Hosp. J., 6: 106, 1957. 
SiLVEK, A. A. and Shaw, H. M.: Toward further simplification of the diabetic diet, Sinai 

IIosp. J., 6: 99, 1957. 

F. Ldiicntiuiial Activities: Lectures, Seminars and Conferences to Medical Groups off 

Campus. 

Deholf, I. I).; "The Doctor and the Over-weight Patient"; Eighth Post-Graduate 
AssembK , Doctors Hospital, January 19, 1956. 

Entuisle, d.: Post-Graduate Course, Walter Reed Army Medical Center, Anti- 
biotics in the Meningitides, Participant, November 16, 1956. 

Entwisle, G.: "Sarcoidosis", St. Agnes Hospital, March 28, 1957. 

Entwisle, G. : "Sarcoidosis", Marvland General Hospital, May 28, 1957. 

Entwisle, G. : "Chemoprophylaxis of Infectious Diseases ", Am. Coll. of Health Asso. 
April 25, 1957, Lord Baltimore Hotel. 

G. Needs of the Division 

a. Space— The Medical Clinic area is at present too small to handle the current 
load of the clinic. More examining areas are needed. The use of other clinic 
areas for this is the current solution, but not an ideal one. 

b. Perso^ne/— There has been variation in the number of house officers assigned 
each month to the Medical Clinic during the past year. In addition, vacations, 
medical meetinps, and illnesses have further varied the number of house officers 
in the OPD during a given month. A more stable, or at least a more predictable 
number of house officers, is needed for greater eflficiencv in the Medical Clinic. 

In January, 1957, residents from the Marvland General Hospital began 
rotation through the Medical Clinic of the Universitv Hospital. This was most 
helpful. 

c. Eciuipuient 

When a noon "conference time" becomes available, an additional blackboard 
in the classroom will be helpful. An appropriate slide librarv for use in 
teaching at this time is being collected. When these sessions are held four days 
a week (excluding Tuesdays for medical grand rounds) a projector and screen 
will be needed for use in this classroom. 

An electrocardiograph will be needed for the amplified Home Visit Program 
next fall. An expirograph, of great benefit in teaching pulmonarv physiology 
to students, would be most helpful. In addition, this will be of definite benefit 
to the Chest Clinic where it will also serve as a diagnostic tool. Two Schiotz 
tonometers are needed so that routine tonometry can be done on all new patients 
over the age of 50 as part of their complete work-up. 

DIVISION OF PHYSICAL DIAGNOSIS 

A. Personnel: 

Marriott, Henry J. L., M.D. Associate Professor of Medicine and 

Head of Division 
Richardson, Aubrey, M.D. 
and Staff 



DEPARTMENT OF MEDICINE 85 

B. Grants-in-aid: 
None. 

C. Ctmicidar Activities: 

Instruction of sophomores, 16 vvecklv 3 hour sessions, during 2nd semester. 

D. Research Activities: 
None. 

E. Ptihlications: 
None. 

F. Educatiu}ial Activities: 
None. 

G. Needs of Division: 
None. 

DIVISION OF RADIOACTIVE ISOTOPES 

A. Personnel 

Bauer, Robert E Co-Director— Assistant Professor of Medicine 

Workman, Joseph B Co-Director— Assistant Professor of Medicine 

Patten, David H Fellow in Medicine 

Dennis, John M Consultant, Professor of Radiology and Head, 

Department of Radiology 

B. Grants-in-aid-1956-1957 

Source Amount Title 

American Cancer Society $6,102.00 Radioisotopes in Cancer 

U. S. Public Health Service. . . . 2,300.00 Diodrast (1-131) in Renal Function 

E. R. Squibb & Sons 2,500.00 Fellowship Training 

C. Citrricidar Activities 

Members of the Division have participated in the teaching of the medical uses 
of radioactive isotopes as applied to the basic sciences— notablv Phvsiologv, Bio- 
chemistrv and Pharmacology— to the freshman and sophomore students. 

Ward rounds and seminars, some in collaboration with the Di\'ision of En- 
docrinologv, ha\'c been conducted for the senior students and interested resident 
staff. 

Lectures and seminars for the junior and senior classes, house staff, and facultv 
members have been presented at the Tuesdav Clinics (LIni\'ersit\ and Mercv 
Hospitals). 

D. Research Actiinties 

1. The importance of serial blood \ olumc determinations in the c\ aluation and 
management of heart failure is being evaluated. The various methods of measure- 
ment (RISA, Cr-51 or simultaneous RISA and Cr-51) are being anahzed in order 
to select the most reliable and practical method. (In cooperation with the Di\'ision 
of Cardiology.) 



86 BULLETIN Of THE SCHOOL OF MEDICINE, U. OF MD. 

2a. riic proper role oii raclioactixc iodine in the diagnosis and theraj)\ ot th\ roid 
nodules and thxroid malignaney is long oxerdue for a critical evaluation. The fre- 
quenc\ ot the nodular goiter and its low incidence of malignancy strongly suggest 
that the proplnlactic removal oF all thxroid nodules to prevent later malignant 
deseneration is ill-advised. It is our intention to determine if this confused situation 
can be clarified b\ a combination of the available methods including: (I) physical 
examination, (2) P.B.I.. (3) 1-131 uptake and scan, (4) 1-131 uptake response after 
T.S.H. and thvroid extract, and (5) the response of the nodular disorder to a 
therapeutic trial with thyroid extract. 

2b. To date we have treated 65 patients with thyroid malignancy. Our results 
have been occasionallv dramaticalK successful but, in general, discouraging and 
inadequate. Therapeutic programs in the recent literature have fluctuated between 
the extremes of (1) radioactive iodine combined with complete thvrcjid ablation and 
(2) the more conservative approach of less complete thvroid surgerv, repeated as 
indicated, combined with long term therapv with thyroid extract. The advocates 
of this latter approach have stressed the importance of available T.S.H. in the 
continued growth and spread of thvroid carcinoma which thev attempt to reduce 
bv the administration of exogenous thvroid extract to supplement the endogenous 
supplv. Our current program is aimed at slowing the rate of growth and spread of 
thvroid malignancv after adequate surgerv by the administration of thyroid extract. 
Thvroid ablative surgerv plus large doses of 1-131 are reserved for those few select 
patients with demonstrable metastases who have high 1-131 uptakes. (A part 
of this studv is in cooperation with the Department of Surgery.) 

3. The therapv of hvperthvroidism with radioactive iodine has been a con- 
tinuing program since 1950 during which time over 300 cases have demonstrated 
good results in over 80 per cent. Special consideration is being given to (1) 
patients with hvperthvroidism, recurrent after surgery, (2) patients with hyper- 
thyroidism complicated bv heart disease, and (3) the more precise evaluation and 
therapN of the nodular goiter with its masked toxicity and its high incidence of 
associated cardiac disorders. TPart of this program is a cooperative study with the 
Division of Cardiology.) 

4. The treatment of selected euthyroid cardiacs with radioactive iodine has 
been completed and evaluated in 18 patients. The purpose of this therapy is to 
create a favorable balance between metabolic demands and a failing cardiac reserve. 
It has been shown to be successful in approximately 50 per cent of the cases so 
treated. Certain inadec|uacies have become evident and the current studies are de- 
signed for more precise evaluation of the role of psychiatric factors and the rigid ad- 
herence to strict medical regimes prior to the inclusion of candidates in this study. 

5. Some selected cases of sterilitv, abortion, prematuritv, obesity, and even 
mental deficiency may be due to subclinical disturbances in thyroid physiology. 
These particular cases can properly be categorized as having a "low thyroid reserve" 
(inability of the thvroid gland function to adequately respond to sustained physio- 
logical stress such as pregnancy). The measurement of P.B.I, and 1-131 uptake 
before and after the administration of T.S.H. offers a suitable test device to deter- 
mine the adequacy of the individual thvroid reserve based on its response to 



DEPARTMENT OF MEDICINE 87 

physiological stress. The results oF the initial studies have been fairly selective and 
the response to dehnitive therapy with thyroid extract has been encouraging. (Part 
of this study is in cooperation with the Department ol Obstetrics.) 

6. The use of radiogold in the management ol patients with late carcinomatous 
processes complicated by intractable ascites and/or pleural effusions has been a 
continuing study since 1950. In June, 1956, the analysis of 60 cases was reported 
in the American Journal of Roentgenology , Radium Therapy and Nuclear Medi- 
cine, 75: June, 1956. We are now extending the study to compare the effectiveness 
of nitrogen mustand combined with x-ray therapy with that of radiogold in the 
management of these difficult problems. 

7a. A research program, in which radioactive iodine tagged diodrast is used 
as an indicator in the study of renal function, was begun during the summer of 
1956. The program is in cooperation with the Division of LIrology of the Depart- 
ment of Surgery and a small research grant was obtained from the United States 
Public Health Service (USPHS) to provide necessary electronic ecjuipment for this 
pilot study. 

To date, a number of renograms have been performed, and, although a greater 
number in a larger variety of clinical conditions are necessary before the test can be 
properly evaluated, it is felt that our preliminary results show considerable promise. 
It is planned to compare tracings obtained by diodrast with those obtained with a 
second urography dye, Renografln, which is being tagged, especially for this study 
with 1-131 by E. R. Squibb & Son Radiopharmaceutical Division. 

7b. In May, 1957 E. R. Squibb & Sons very kindly began supplying the Divi- 
sion with tracer amounts of Cobalt-58 labeled vitamin B-12 for study of macrocytic 
anemias. Prior to this time the long half life isotope of cobalt— namely Co-60 with 
half life of 5 years— was the only tagged BT2 available. Because of the high energy 
gamma j^roduccd by the Co-60 isotope and its long half life, dosage of the tracer 
had to be kept at a minimum making clinical accuracy poor. 

Co-58 has a half life of 70 days thus allowing a larger and more efficient tracer 
dose and increasing validity of the test. We are the first unit in this area to have 
received Co-58 B-12 for clinical use in humans. 

7c. Studies are imderwax' in other fields as well: 1131 labeled Rose Benoal 

o 

in tracer amounts is concentrated by the li\'er. Used in conjunction with scinti- 
scanner, hepatograms or tracing of functioning liver tissue ha\'e been made. It is 
too soon to evaluate the usefulness of this procedure. However, should sufficient 
interest be shown by cooperating agencies, information as to hc]")atic fimction may 
well be forthcoming. 

Puhlicatious-juW 1, 1955-Junc 30, 1957 

Workman, J. B.: The peaceful atom, Bulletin Alumni University of Maryland School of 

Nursing, 1955. 
Crosby, R. M. N.; Bauer, R. E.: Subdural collections of fluid in infants and children, II. 

Study with radioactive sodium phosphate (P-32), Journal of Neurosurgery, Vol. XIII: 

No. 2, 140-144, March, 1956. 
Bauer, R. E.: The present status of the diagnosis of hyperthyroidism, (Editorial) Annals of 

Internal Medicine, Vol. 44: No. 1, January, 1956. 



88 HI// / fcT/\ OF THE SCHOOL OF MEDICINE. U. OF AID. 

Dennis, J. M.; W'oukman, ]. B. and Uaiiiu, R. E.: Radioactive colloidal yold in the control 
of malii'nant effusions. Report and analysis ot" 60 patients. The American Journal of 
Roentijenologx , Radium Therapy and Nuclear Medicine, Vol. LXXV: No. 6, June, 1956. 

Yeagek. G. H.: W'oukman, ]. B.; I Iolbkook, W. and Patten, D. H.: Thyroiditis: A review 
and presentation of forty pathoKwically proven cases of chronic thyroiditis. (Accepted for 
publication in the Southern Medical Journal). 

F. Eiiiicaiioiial Act'nitics 

October 1 1 "Radioisotopes in Medicine 

Dr. Joseph B. Workman. Staff Meeting, Mar\hind C.cnci,il Hos- 
pital, Baltimore, Maryland 

i\o\eniber 8 "Llse of Radioacti\e Iodine in Diagnosis of Tlivroid Disorders" 

Dr. Joseph B. Workman. Staff" Meeting, Mercv Hospital, Balti- 
more, Mar\'land 

December 2 "Th\ roid Diseases, Diagnosis, and Therap\" 

Dr. Joseph B. \\^)rkman. Staff Meeting, Pro\ ident 1 lospital. 
Baltimore, Marx land 

December 14 "Llse of Scintiscanner in the Detection and Management of Tin roid 
Carcinoma" 

Dr. Joseph B. Workman. Cancer Section, Baltimore Citv Medical 
Society, Joint Meeting with NTI I. llni\crsit\ 1 lospital, Baltimore, 
Maryland 
1956 

January 5 "Use of Radioisotopes in Therapy of Malignancy" 

Dr. Joseph B. Workman. Staff Meeting, Mercy Hospital, Balti- 
more, Maryland 

hebriiary 16 "Thyroid Disorders, Diagnosis, and Management" 

Dr. Joseph B. Workman. StalF Meeting, St. Agnes Hospital, 
Baltimore, Maryland 

March 3-7 Dr. Joseph B. Workman, Dr. John M. Dennis, Mrs. Dorothx De 
Santis, and Janet Estes. Ccntennial-Scsquicentennial Celebration, 
College Park, Maryland. Booth as part of School of Medicine 
display. 

March 16 "Value of Blood Volume Determinations b\ Radioisotope Methods 

in Various Disease States " 

Dr. Joseph B. Workman. Eastern Conference of Radiologists, 
Baltimore, Maryland 

March 26 "Llse of Radioisotopes in Clinical Medicine" 

Dr. Joseph B. Workman. Staff" Meeting, Washington Sanitarium 
& I lospital, Takoma Park, Marxland 

Ap\\\ 4 /Xmerican Cancer Society— "Until Tomorrow— Use of Radioisotopes 

in the Detection of Cancer" 

Dr. Joseph B. Workman and Mrs. Dorothy DeSantis. Telexision 
Program-WA/\M-^A^ Baltimore, Maryland 



DrVARTMFNT Or MEDICINE 89 

IMa\' 25 "Use ot Scintiscanner in the Diagnosis and I reatnient ol Iluroid 

Disortleis 

Dr. losepli 1). WDrknian. Societ\ lor l.xpeiiniental Biolo^x and 

Medicine Mai\lantl Section. ,\rni\ C'liemical Center, Mainland 
August 21 "I 1.^1 riierain I liMoid Cancer" 

Dr. Joseph 1>. Workman. Mechcal Stall". V. A. I lospital. Fort 

I lowartl, Mar\ land 
Octoher 10 "llnroitl Disorders, Diagnosis antl Ireatment" i A a part ol Post- 
Ciratluate Course IkisIc Plnsiologx' as Applieil to C linical Medi- 
cine^ 

Dr. Joseph B. Workman. Delaware Acadenn Cieneral Practice, 

Wilmington, Delaware 
October 30 " Ihe Tluroid and Radioactixe Iodine" 

Dr. loseph P). Workman. Smgical Stall Meeting, Iraidvlin Stpiare 

1 lospital, Baltimore, Mar\land 
INovember 2 "Latest Uses ol isotopes in Diagnosis and I reatment" (^/\s a part 
of Scries— Recent Ad\ances in Mctlicine) 

Dr. Joseph B. Workman. Post Ciratluatc Institute. Doctors I los- 
pital, Baltimore, Mar\land 
November 12 "Radioisotopes in Medicine" 

Dr. loseph P. Workman. Formal Discussion ol paper presenlctl h\ 

Dr. Howard /Vndrews, Cieneral Practice Session, SOth Annual 

Meeting Southern Medical .Association, Washington, D. C . 
No\emher 15 "Ratlioactix e Isotopes 1 heir Rise in Diagnosis antl 1 herap\ " 

Dr. loscjih B. Workman. Post Ciraduate Series, St. Agnes 1 los- 

jiital, P)altimore, Mar\iantl 
Noxember 18 "Ihe llnroitl Ciland — Past, Present, and Future" 

Dr. Robert F. Inuicr. UniversitN' of Mar\ laml I ele\ ision Program 

-WB/\L-TV. Baltimore, Marx'land 
December 11 "Inleetious Moncniucleosis" 

Dr. Jos(.-ph P). Workman. St. ill Meeting, Mercx I lospit.d, IViIti 

more, Marx land 
December 13 "Ibxroid Disease, Diagnt)sis, antl 1 herapx ^ As p.iit ol Section on 
Endocrinology) 

Dr. Joseph B. Workman. Post-Ciraduate Lecture- Marxkintl 

Academx' Cieneral Practice, Baltimore, Marxland 
1957 
Januarx' 18 "Chemotherapx ol Malignant Disease" 

Dr. Joseph B. Workman. Surgical Stall C^)nrerence, Church 

Home Hospital, Baltimore, Marxlaiul 
Febriiarx' 20 " I hxroiditis, Diagnosis, and Management 

Dr. Joscjih B. Workman. Pialtimore Countx Medical StK'ietx , 

Stall'ord Hotel, Baltimore, Marxlanil 



90 BULLETIN OF THE SCHOOL OF MEDICINE, 17. OF MD. 

Februarx 20 "Llscs ol Radioisotopes in Medicine" 

Dr. losejih B. W'oikiiian. Post Ciraduate Ccnnmittee Basic Science 

Course, Baltimore, Marx land 
March 8 "iMedical Uses of Radioisotopes— 1 Basic Concepts" 

Dr. Joseph B. Workman. Entire Staff, V. A. Hospital. Fort 

Howard, Maryland 
March l-t "Physiology of Thyroid" 

Dr. Joseph B. Workman. Post-Gradiiatc Committee— Basic Sci- 
ence Course, Baltimore, Maryland 
March 13 "Diagnosis and Treatment of Thyroid Disorders" 

Dr. Joseph B. VWirkman. Post-CTraduate Committee— Basic Sci- 
ence Course, Baltimore, Marx land 
March 22 "Medical Llses of Radioisotopes— 11 Blood X'olumc in 1 leaith and 

Disease" 

Dr. Joseph B. Workman. Staff Meeting, \'. A. Hospital, Fort 

Howard, Maryland 
March 27 "Application of Radioisotopes to Pediatrics" 

Dr. Joseph B. Workman. Staff Meeting, Dept. of Pediatrics, 

University Hospital, Baltimore, Maryland 
April 5 "Medical Llses of Radioisotopes— III Medical Research Applications" 

Dr. Joseph B. Workman. Staff' Meeting, V. A. Hospital. Fort 

Howard, Maryland 
April 11 "Medical Management of Thyroid Disorders" 

Dr. Joseph B. W'^orkman. Sussex County (Delaxvare) Medical 

Society, Delaware 
April ->0 "The Thyroid and Heart Disease" 

Dr. Robert E. Bauer. Medical Staff Meeting. Mercy Hospital, 

Baltimore, Maryland 
May 4 "Clinical Uses of Radioisotopes" (Discussant— R. E. Bauer) 

Dr. Robert E. Bauer. Annual Medical and Surgical Symposium. 

Lutheran Hospital. Baltimore, Maryland 
May 5 "Medical Uses of Radioisotopes" 

Dr. Joseph B. Workman and Dr. Dax id II. Patten, LInixersity of 

Maryland Tclcyision Program, WBAL-TV, Baltimore, Maryland 
May 22 "Clinical Uses of Radioisotopes ' 

Dr. Daxid II. Patten. Post-Craduate Biochemistry Seminar, Balti- 
more, Maryland 
May 2?> "Radioactixe Iodine as a Tool in Diagnosis and Treatment of 

Thyroid Disease" 

Dr. Joseph B. Workman. Tri-County Medical Society, Purdue 

Unixersitx , Lafaxette, Indiana 

G. Needs of iJic Division 

The existing situation in the Division of Radioactixe Isotopes is critical and in 
a sense unique. The groxxth rate of the "laboratory serxice" has been unusually 



DEPARTME?<T OF MEDICINE 91 

rapid and at the present time the serxice load (I- HI uptake, 1-131 therapy, blood 
volumes, scintiscans, etc.) is approaching capacity; occupying o\'er 80-90 per cent of 
the total a\ailablc time— secretarial, technical, and professional. The unfortunate 
result has been the noticeable curtailment of research actixities. Moreover, the 
permanent isotope ecpiipment (scalers, monitors, spectrometers, scanners, etc.). 
essential for the proper function of the laboratory, has o\errun the allocated physical 
space. The remaining working area is woefullv inadequate and seriously over- 
crowded. 

The pressing needs of the Division include: 

1. Spnce— Research activities and laboratorv ser\ice will be seriouslv handicapped 
and probablv reduced until an additional area of approximatelv 200 square 
feet is made a\ ailable for proper positioning of permanent equipment and the 
expansion of the sexerelv restricted working area. This additional space does 
not have to be adjacent to the existing laboratorv but should be easily accessible 
to all types of patients. 

2. PersouueJ— Two technicians and one secretarv are emploved through the hos- 
pital to handle the laboratorv ser\ice load. One fellowship is currently available 
through a grant-in-aid. A request is made for an additional stenographer, at 
least, on a part-time basis. 

3. Research Fjinds—A grant-in-aid of $2,500 to S3,000 per vear is necessarv to 
provide continuing support for one Fellow. 

An additional SI, 500 to S2,000 per vear is necessarv to proxide for repair 
and replacement of equipment and the purchase of supplies. To insure the 
proper maintenance of the elaborate isotope equipment, S750 to SI, 000 should 
be available to a consulting electronics ensineer. 



1)1 PAinMl'NI Ol OBSTETRICS AND (;YNr,CX)I,(X;Y 

Ilcin I 
(;r,Ni:nAi. siAiiiMKNi oi oj-ihaiinc i>i an and ideology 

In general, tlic Dcpartnicnl of Ohstclrits ami ( ivnctolouv {ulfills tlic same function 
of any clinical clc|Kiilnicnl in tlic Medical School in |)ro\'iclin(^ lor tlic care ol |)alients. 
It exists primarly lor I lie tare ol obstetric and uynecoloc^ic |)atieiits. Patient care 
should he |)rovided on a su|)erior level. This inclutles the usual aspects ol medical 
care, nursinu care, and house stall care. /\ sincere altem|)t is made to consider the 
personality needs ol the patient as well. In all instances, whether the patient is ward 
or j)rivate, an intentional ellort is made to make her (eel as il she belongs in the 
University I Ios|)ital. I acilities are provitled lor all asj^ects of private and ward in-patient 
and out-|5atient care. 

The second reason lor the existence ol the Deparlnient ol Obstetrics and ( iyne- 
colo(;v in the Medical School is loinid in the various as|)ects ol the teachin^^ ol this 
disci|)line. Ibis includes instruction and patient experience for medical students, 
nursin<; students, the graduate nurse, house oditcrs, and the practicin*^ phvsician. 

I hirdiv, it is the I unction ol this department to provide certain laboratory services 
to aid the physician in the care ol patients. I his ser\'ice I unction at present includes the 
determination ol chorionic uonadolrophin, lollic Ic slimiilalinu hormone, protein boinid 
iodine, and sperm counts ol the liunian male. 

rourthjy, research as it relates to the basic problems ol re|)roduction is bein^^ carried 
out in the laboratories of the I)e|xirtment of Obstetrics and (gynecology. Serir)iis efforts 
are made to induce and assist the several members of the de|xirtment in clinical research 
or l")asic laboratory i^roblems as they relate to clinical problems. At the present time, 
praclicinj^ |)hysicians, medical students, house officers and full time members of the 
stafi are enfia<ied in the research programs ol the Department ol ()bsletrics and 
( .\ necolojiy. 



r) n 



Item 2 

l-ACUn.lY AND SIAFI- 

The duties ol the I aeult\ and Stall are \aried. Ibis xariance is due to an attempt 
to utilize each member ol our I acuity and Stall to his utmost in the teaching, research, 
and service I mictions ol the department. During the liscal year under consideration 
there were lour lidl time members of this department. I hese consisted of a Professor 
and I lead, Prolessor, and two lull time Instructors. I hese individuals devoted approxi- 
mately 10 |)er cent ol their time to the jirivate |)ractice ol obstetrics and l;\ necolouy 
and the remaininu to ccinsultatioii, teachinc^, ;incl research. The major burden of house 
stall res|)onsibilit\ lalls to these lour lull time stall members. In rotation, the\' serve as 
the major consultant on ward services in obstetrics and uNiiccolouy. Their chief value 
as ccMisultants other than prolessional excellence and interest, lies in their ready 
av ailabilitv to the house olliccr lor immediate consultation. 

93 



94 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

The part-time staff member, who receives a small stipend lor his efforts, consisted 
in the past fiscal year of an Associate ProFcssor, two Assistant Professors, and two 
Assistants. In general, these individuals have maintained a responsibility in a primary 
clinical area. One of the Assistant Professors is in charge of the Cancer Clinic, an 
Assistant aids in the preparation of records, and the other Assistant is in charge of the 
Clinic. 

In addition to the full-time and part time, are the large number of our Faculty and 
Staff who serve as volunteer assistants without remuneration. The major portion of 
their availability and use, other than in the care of prixatc patients, have been in the 
teaching of medical students and house officers. These men have been relieved of all 
ser\'ice resjwnsibilities and haxe been gi\'en small but important assignments in the 
various instructional areas. 

A group of six men have ser\ed as ()j>erati\e consultants in the g\ necologic service. 
Their function has been to assist the residents in one major operation a week. Their 
period of service has rotated throughout the year. The value of this exercise is, of course, 
obvious. It allows the resident to acquaint himself with the various techniques utilized 
by the se\'eral practitioners. Another small group of men have been engaged in the 
teaching of office gynecology to the fourth year students. Ten voluntary assistants have 
been engaged in the teaching of third year students in the presentation of planned 
material. Student rounds at Unixcrsity and City Hospitals haxe been made regularly 
by the volunteer assistants. 

In addition to these planned teaching exercises, each pri\atc ])hysician has been 
urged to utilize his own patient material to the utmost in the instruction of house 
officers and medical students. It should be stressed that the men have never been 
requested to turn over operations or deliveries or the mechanics of patient care. Instead, 
the private physician has been urged to instruct the students and house officers in 
operati\'e technique and in the technique of delivery. It is hoped that from this type 
of relationship, the medical student and house officer can readily acquaint himself with 
the manner in which private patients should be managed. 

The obstetrical program at Baltimore City Hospitals has been for the fourth year 
medical students. The full-time instructional staff has consisted of three men, an 
Assistant Professor and two Instructors. The salaries of one Assistant Professor and one 
Instructor have been paid in part from the Budget of the Department of Obstetrics 
and Gynecology. 

Item 3 

TEACHING 

Teaching of the third year medical students has changed somewhat in the last fiscal 
year. The instructional time has been increased from four weeks of obstetrics as it 
existed in the past, to six weeks of combined obstetrics and gynecology. During this 
time the students are seen in small groups and the entire teaching program is repeated 
each six weeks. 

In summary, there are thirty seminars which the students attend in small groups 
and in which they discuss the outlined material as related to obstetrics and gynecology. 
There ha\e been basic science discussions on a weekh' basis, led by the sc\'cral members 



DEPARTMENT OF OBSTETRICS AND GYNECOLOGY 95 

of the Basic Science Departments of the Medical School. Obstetric and Gynecologic 
Pathology, as it relates to the clinical aspects of obstetrics and gynecology, has been 
presented by a member of the full-time staff of the Department of Obstetrics and 
Gvnecologv. The usual staff conferences and rounds have been carried out, in addition 
to manikin practice and the other specialized instruction peculiar to obstetrics and 
pvnecolos^'• 

At the beginning of their block on obstetrics and gvnecologv the students were all 
instructed that the philosophy of the Department was not primarih' to teach but to 
afford the student the opportunitx to learn. With this thought in mind, the didactic 
lecture svstem has been completcK' eliminated. The students ha\'e been assigned to 
both ward and pri\ate patients. Thev have assisted on both ward and pri\ate deli\'eries 
and thev have assisted in operative procedures on both ward and private gynecologic 
patients. The students have been urged to follow the patients in labor and to assiduously 
follow the gynecologic patient preoperatixelv and postoperati\ely. /Ml planned exercises 
ha\'e been considered to be secondar\ to actual patient instruction during these six 
weeks. AccordingK, the students haAC been expected to attend assigned patients in 
labor or in the operating room rather than conflicting planned exercises. 

Fourth year medical student teaching consists of a four week period. For two w eeks, 
the medical students are assigned in groups of approximately eight to Baltimore City 
Hospitals. During these two weeks, the student is expected to apph the theoretical and 
practical knowledge obtained in his third ACar. These two weeks are primarily designed 
to give the man an opportunit\ to operate at a high le\el of responsibility in caring for 
obstetrical patients. The axerage student will deli\er twent\-fl\e patients during his two 
weeks sta\ at Baltimore Cit\- Hospitals. In addition to the practical work, there ha\e 
been planned rounds cUid seminars. 

The remaining two weeks of the four week period are spent at the LIni\ersitv 
Hospital. The student works in the Out-Patient Deixirtment Clinic, in the general 
clinic, in the Prenatal Clinic, and in spccialtx clinics. 1 le participates in the original 
work-up ot the g\ necologic and obstetrical patient and is tutored b\ the practicing 
attending physician, or in his absence, resjionsiblc house ollicers or full-time men. A 
special program designed toward orienting the students in the ottice practice of g\ne- 
cology is presented. He attends the regidarb' scheduled g\ necological cancer clinic, and 
endocrine antl inlertilit\' clinic. In this short two week assignment of time, the student 
is expected to learn the lundanienlals ol the ollice i^ractice ol obstetrics and g\ necolog\" 
as contrasted to the in-patient care as learnctl in the third year. 

Teaching as it is concerned with the instruction of student nurses and graduate 
nurses is carried out whenexer rei|ucstetl In the nursing tlepartment. Teaching as 
applied to the residencx program will he considered untler the i^raclii.ik" program. 

Item 4 

RESEARCH 

It is the exjiressed opinion ol the Department of Obstetrics and C.\ necolog\ that 
the research appro.ich to medicine is imjiorlant in .ill aspects of medicine. Specihcallv, 
the research apjiroach is as important to a general practitioner as it is to an academician. 
Medical student research is stimulated and nurtiucd whenexer the desire seems to 



96 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF AID. 

become apparent in the individual student. A specific grant of money from the Josiah 
Ahicv. jr. Foundation for inducing the medical student towards the research aspects 
of reproduction has been obtained. During the fiscal year under consideration, three 
medical students were utili/cd in the laboratories of the Department of Obstetrics and 
Gvnecologw Although onh one publication has been forthcoming from this effort, the 
experience obtained by the students is considered to be invaluable and unique in that 
it is not obtainetl in the regular curriculum of the Medical School. 

In a similar manner, research interests are cultixated in the house oflficer. The full- 
time staff is, of course, expected to participate voluntarily, readily and willingly in 
research programs. Research interests of part-time and voluntary assistants are also 
stimulated and nurtured. 

The research attempted and the projects currently active in the Department of 
Obstetrics and Gynecology in the current fiscal year are listed. 

1. Metabolism of intravenouslv administered progesterone (radio-tracer studies). 

2. The basic aspects of metabolism of intravenous progesterone in rabbits. 

3. The quantitative determination of chorionic gonadotrophins in blood, urine, 
and stool. 

4. The production of afibrinogenemia, using intravenous amniotic fluid. 

5. The prevention of afibrinogenemia in rabbits following the intravenous ad- 
ministration of amniotic fluid. 

6. Th^'roid metabolism in pregnancy. 

7. Tranquilizing drugs in dysmenorrhea. 

8. Anatomic studies of uterine fibromyomata. 

9. The genesis of locked twins. 

10. The evaluation of synthetic oxytocin. 

11. The carcinogenic effect of low intensity irradiation on the endometrium. 

12. The study of shoulder dystocia. 

13. The use of bioflavinoids in the pre\'ention of the accidents of isoimmunization. 

14. The continued statistical analysis of the obstetrical data. 

15. The statistical coding of all gynecologic admissions, as a new project. 

16. Coding and follow-up of all gynecologic cancer. 

Item 5 

GRADUATE PROGRAM 

The graduate program as it refers to the house officer and specialty training in 
obstetrics and gynecology has consisted of the training of fifteen house officers for this 
year. Of this group of men, three are eligible for the American Board of Obstetrics and 
Gynecology. One man is coming into the Department of Obstetrics and Gynecology 
as a full-time Instructor. The remaining two are entering private practice, one in this 
community and the other in Florida. Two men are being dropped from the program 
and a third is being retained as a Fellow. 1 he remaining are continuing in the house 
officer prf)gram. Residency training at other hospitals has been obtained for the two 
men not continuing in our program. 



DEPARTMENT OF OBSTETRICS AND GYNECOLOGY 97 

There are planned exercises for the house officer group. These consist of a weekly 
staff conference, a weekly house staff conference, a monthly obstetrical and gyne- 
cological pathology conference, a monthly Baltimore City Maternal Mortality meeting 
at the Medical Surgical Faculty, a weekly junior Staff Conference during the school 
year, student rounds on obstetrics and gynecology three times weekly, a Fetal Mortality 
Conference, once monthly, in conjunction with the Department of Pediatrics. 

The planned exercises are important in the house officer training program. It is 
stressed, however, from a philosophical standpoint with our house officers, that post- 
graduate training is simply the rapid accumulation of experience. To this end, the 
physician is urged to avail himself to the utmost of the various clinical opportunities 
present. He is urged to attend the regular clinic sessions, even though he may not be 
assigned to them. He is urged to attend the various specialty clinics. He is urged to see 
as many patients as he can and to engage into as manv diagnostic and therapeutic 
procedures as he can. In addition to this, he is constantly reminded that consultation 
is ever present, at his fingertips. 

The house officers are, in effect, in charge of the Out-patient Clinic. Their responsi- 
bilities are, of course, subject to modification and are necessarily dependent upon the 
consultation a\'ailable. The work load, as far as care of patients is concerned, is primarily 
a duty of the house officer. In the past fiscal year, there were 23,851 clinic visits in 
the obstetric and gvnecologic clinic. Of these, 16,755 were obstetric out-patient visits 
and 7,096 were gynecologic out-patient visits. The responsibility of the house officer 
for in-patients, of course, is not limited to the clinic or ward patients but is extended 
to the private service as well. During the fiscal year July 1, 1955 through June 30, 
1956, for which our statistics are available, there were 3,482 obstetric patients. Of 
these, 1,316 were private and 2,166 were ward patients. 

For the fiscal year under consideration, there were 1,253 gynecologic admissions. 
Of this, 739 were ward patients. There were 1,058 gynecologic operations of which 
approximately 50 per cent were ward and 50 per cent were private. 

The clinical material available for the instruction of resident physicians was ex- 
cellent and it is increasing in amount. It is apparent that within a very short period of 
time additional bed space will be required. This will be required particularly in the 
care of the cancer patients. The cancer patient's treatment in the past vear has neces- 
sariK' been somewhat prolonged due to the inabilitv to admit the patient for radium 
therapy as soon as desired. 

The graduate program also extends to the practicing phvsician. A serious post- 
graduate program was undertaken at Peninsula General Hospital in Salisbury. A 
resident phvsician from this department is there throughout the vear. The Salisbury 
phvsician and the resident physician attend the wccklv staff conferences at the Uni- 
\ersit\' 1 lospital. In addition to this, the monthK' staff conferences at Peninsula General 
Hospital are attended by members of this staff. A similar graduate program was carried 
out at Easton Memorial Hospital with the exception of the house officer assignment. 
No house officers ha\c been sent to Easton but the monthly staff' conferences are 
attended b\' one plnsician from our staff. In addition to these planned conferences, our 
phvsicians ha\c contributed hca\ i!\ to postgraduate education at other hospitals in the 
city. 



98 BULLETiy^ OF THE SCHOOL OF MEDICINE, 17. OF MD. 

At Maryland General Hospital, the lollowing presentations ha\e been made dining 
the vear bv full-time physicians: 

"The Obstetricians Responsibility to the Fetus" 
"Heart Disease in Pregnancy" 
"Cesarean Sections— Types and Their Indications" 
"Pregnancy and Sickle Cell Anemia" 

At St. Agnes Hospital : 
"Breech Presentation" 
"The Third Stage of Labor" 

At Bon Secours Hospital: 

"Pehametry" 

"Cesarean Sections— Types and Their Indications" 

At Women's Hospital: 
"Pelyimetry" 

In addition to postgraduate education on a citv and state basis, the Department of 
Obstetrics and Gynecology has contributed to postgraduate education on a national 
le\el. At the Hartford Memorial Hospital in Hartford, Connecticut, the following 
papers were presented: 

"Stilbestrol Therapy for Pelyic Endometriosis" 

"Endocrinology in General Practice" 

"The Hormonal Pattern of Uterine Bleeding" 

At the Ogden Surgical Society in Ogden, Utah: 

"The Use of Pitocin" 
"Heart Disease in Pregnancy" 

At the Utah Obstetrical and Gynecological Society in Ogden, Utah: 

"The Thyroid in the Pregnant Female" 

At the West Chester County Medical Society, White Plains, New York: 

Seminar concerning The Maternal Mortality Committee 

At the U. S. Army Hospital in Aberdeen: 

"The Third Stage of Labor" 

"Cesarean Sections— Their Types and Indications" 

"The Hormonal Control of Uterine Bleeding" 

"Choriocarcinoma" 

At the Georgia Academy of General Practice, Savannah, Georgia: 
"Preserving the Perineum" 

Postgraduate education for others and members of the Department have been 
accomplished by participation in a number of National and International Society 
meetings. These include: 

The Biological Photographic Association meeting in Rochester, New York 
The Annual Convention of the Association of Medical Illustrators, Iowa City, Iowa 
The course in Gynecology at the Harvard Medical School 
Medical Society meeting at the University of Rochester 

Inspection of Record System for Cancer patients at Kings County Hospital, New York 
City 



DEPARTMENT OF OBSTETRICS AND GYNECOLOGY 99 

American Cancer Society, Annual Scientific Session, New York City 

American College of Obstetrics and Gynecology, Chicago 

Society for Gynecologic Investigation, Chicago 

The Continental Gynecologic Society, Miami 

The American Cancer Cytology Conference, Miami 

The Endocrine Society meeting, New York 

The American Society for the Study of Sterility, New York 

The Obstetrical and Gynecological Section o£ the American Medical Association in New 

York 
The North American Gynecologic Society, Columbus, Ohio 

The following papers were presented at National Scientific meetings: 

"The Intravenous Metabolism of Progesterone in Rabbits" at the Continental Gynecologic 

Society in Miami 
"Thyroid Function in Pregnancy" at the American College of Obstetrics and Gynecology 

in Chicago 
"Fetopelvic Grading in Breech Presentation" at the Obstetric and Gynecologic Section 

of the American Medical Association in New York City 

Postgraduate education has also been contributed to by the participation of the 
department in the Committee for Postgraduate Education for the School of Medicine, 
University of Maryland. 

Item 6 

STATISTICAL ANALYSIS, WORK DONE AND SERVICE RENDERED 

Attention is directed to the enclosed reprint of The Summary of Admissions and 
Perinatal Mortality of the Department of Obstetrics and Gynecology, School of Medi- 
cine, University of Maryland. Apologies are made for the date of this report. It covers 
the fiscal year from July 1, 1955 thru June 30, 1956. It has been customarv in the past to 
present this report in winter of the year following the accumulation of data. It should 
be emphasized that the practicality of preparing this report is based solely on the a\'aila- 
bility of I.B.M. facilities. In addition to this, the great interest of one of the full-time 
staff members guarantees the integrity and honestv of the report. A similar report on the 
gynecologic admissions, surgery, cancer, etc. will be available next vear since, as of 
July 1, 1956, a similar statistical program was initiated on the gynecologic patients. 

The work done and service rendered in regard to the gynecologic patients can best 
be summarized according to the out-patient statistics and the admissions to the hospital. 
During the fiscal year under consideration there were 16,755 obstetric out-patient \'isits. 
There were 7,096 ovnecolooic out-i^atient xisits. There were 82 new oxnecologic 
cancers. The cancer clinic has increased in scojx' and in quantity. The total number of 
admissions to the hospital lor gynecologic procedures was 1,253. There were 739 ward 
|xitients admitted. 

Item 7 

lACIITTIES AND EQUIPMENT 

1 he research tacilitics and equipment that have been obtained in the past \ear ha\ e 
consisted of two rooms, one of which is a small animal operating room. The other room 
is completely ec|uipped for chemical and radio-tracer work. The \'arious pieces of 
ec|uipment that ha\e been obtained are numerous and the total cost for the entire 



100 Bl]LLETl?< OF THE SCHOOL OF MEDICINE, 11. OF AID. 

facility in the past year is ajiproximatcK $25,000. Additional ctiuipmcnt has been 
purchased for the obstetric and gynecologic pathology laboratory consisting primarily 
of microscopes and microscope lamps. Third, the obstetric and gynecologic laboratory 
has. in addition, been equipped with benches for student instruction. Photographic 
equipment essential to the photography of gross and microscopic specimens in obstetrics 
and gynecology haye also been obtained in the past year. Approximately 1,000 photo- 
graphs ha\e been taken of both gross and microscopic specimens. The photographic 
equipment is also used for obtaining pictures, of patients, particularly those with 
endocrine disorders. Copying work is done for the preparation of slides for lectures. 
The clinical facilities and equipment ha\c not changed markedly in the past year. 
There are scheduled changes in the new delivery room area but these haye not \'et 
become material. The operation facilities and equipment are essentially the same. 

Item 8 

COMMUNITY' SERVICE 

Community service may be divided into service to patients which is well covered 
in the statistics and general operating philosophy. Community ser\ice to non-patients 
and potential patients has consisted of television programs and radio programs. In 
addition to this, the \arious members of the department have been urged to participate 
in community activities, such as boy scouts, girl scouts and other non-medical activities. 

Item 9 

PUBLICATIONS 

1. Arthur, R. K., Jr. and Kaltreider, D. F.: The elderly nullipara. Obstetrics and Gynecology, 
August, 1956. 

2. Kaltreider, D. P.: Episiotomy, Current Medical Digest, December, 1956. 

3. Kaltreider, D. P.: The management of the pregnant cardiac. West Virginia Medical Journal, 
January, 1957. 

4. McNally, H. B. and Pitzpatrick, V de P.: Patient with four more cesarean sections, Journal 
of A.M.A., March, 1956. 

5. Rappoport, W. J.; Goldstein, B.; Haskins, A. L.: Intravenous progesterone, basic effects in 
rabbits. Obstetrics and Gynecology, May, 1957. 

6. Siegel, I. A.: Total hysterectomy at the time of cesarean section and in the earlv puerperium. 
Southern Medical Journal, February, 1957. 

7. The University of Maryland, Annual Report, July 1, 1955 through June 30, 1956, De- 
partment of Obstetrics and Gynecology, Bulletin of the School of Medicine, University of 
Maryland, April, 1957. 

Item 10 

RECOMMENDATIONS 

Oitt-patient Departvieut. Many changes are needed in the out-patient department 
but no specific recommendations in regard to equipment or physical plant are made 
due to the hoped temporary nature of the current out-patient area. There is a need, 
hovve\'er. for change as far as physicians is concerned. Of all the teaching enterprises 
in the Department of Obstetrics and Gynecology , the assignments to the out-patient 
department are the least attended. Attendance of SO per cent is considered to be well 
abo\e axeraoe. 



DEPARTMENT OF OBSTETRICS AND GYNECOLOGY 101 

It is apparent, with an out-patient load ol the eurrent magnitude, that a full-time 
physieian should he in eharge and in attendanee in the elinie. For this reason, an 
additional physieian is heing recpiested on a full-time basis. A position of Assistant 
Professor is recommended. 

In-paticut Care. Exaluation of statistics shows an increase in patient load. There 
has been considerable hospital dela\ in the admitting and treatment of cancer patients 
due to the lack of ward beds that could l)c utili/cd lor this, lor that reason, a reappor- 
tionment of beds between the obstetric and gynecologic ward service has been 
recommended. It aj^pears that this plan is approaching the practical point of accomplish- 
ment at this time. 

Research Facilities. The physical plant is very good. We are completely satisfied 
with the allotment of space to this department. There is some difficulty, however, in 
proxiding a continuitN ol research j^rograms due to the fact that a competent research 
director is not always in attendance in the laboratory. For this reason, a new position 
of Research Assistant is recommended. If this can be obtained, it is hoped that a Ph.D. 
or M.D. whose primary interest is in research, could be utilized for fulfilling this 
position. 

Social Service. Social service acti\'itics in obstetrics and gynecology have been 
minimal. This department could use at least one full-time social service worker and 
probably two in the care of obstetric and gynecologic patients. 

Respectfully submitted, 

Arthur L. Haskins, M.D. 



DEPARTMENT OF OPHTHALMOLOGY 

The Department of OphthalmologN' is not functioning as such pending the con- 
struction of an ophthahnology area in LIni\'ersity HospitaL 

TEACHING IN OPHTHALMOLOGY AT THE UNIVERSITY OF MARYLAND 
SCHOOL OF MEDICINE 

]iinior Year 

A series of 14 didactic lectures is gixen, one a week to the entire class. The funda- 
mentals of ophthalmology, including anatomy and physiology of the eye, are stressed 
and as the course progresses, attention is given to the more common diseases of the eye, 
refracti\'e errors, and disturbances of ocular motility. The lectures are supplemented 
with the use of lantern slides. In addition to the lectures, the Junior Class is divided 
into small groups throughout the year, and each group spends several days in the 
dispensary of the Baltimore Eye and Ear Hospital. There ophthalmoscopy is stressed, 
although some attention is also paid to external diseases. The didactic lectures are given 
by Dr. John C. Ozazewski, and the group at the Baltimore Eye and Ear Hospital is 
instructed by Dr. Abraham Kremen. 

Senior Year 

During the Senior Year, small groups make eye rounds on the wards of LIniversity 
Hospital, two to three hours per week for two weeks. Although the stud\' of the fundi 
occupies the most prominent place in this series of ward rounds, attention is also paid to 
external ocular diseases. 

A series of six to se\'en lectures are given, and these lectures are primarily clinical 
in nature. They correlate eye manifestations of general diseases, neurologic ophthal- 
mology, as well as one or two lectures on treatment of acute ocular conditions. Lectures 
and ward rounds are all conducted bv Dr. John C. Ozazewski. 



10?5 



DliPARTMENT OF PA 11 lOLOGY 

GENERAL ORGANIZATION AND POLICY 

Following the rclircincnt ol Dr. 1 high R. Spencer, .-^0 June 1957, the Dean 
requested Dr. John A. Wagner, Professor of Neiiropathology, to conduct the affairs 
of the department |iending the ajipointment of a proiessor of pathology. The expressed 
objective \ie\\s of the Dean as to the lunciioning of the Department were: A. to 
maintain departmental services; B. to institute such changes in procedure and personnel 
as would be consistent with imjiro\ing the general functioning of the organization; 
C. to perform such research as might be possible; D. to reorganize and present a new 
curriculinn in pathology in accordance with the comiiletely rexised princi|iles set lortli 
in the minutes of the C^urriculimi Committee of the 1 acuity, as adojited. 1 he following 
report concerns the extent to which the aho\e luis been accomplished. 

REPORT 

A. Three consultants were n.imed in the Division ol Surgical Pathology. These were 
Dr. Walter C. Merkel, Dr. C Gardner Winner, Dr. Tobias Weinberg. These path- 
ologists rexiewed selected surgical material presented them for consultation by the 
Staff, thus giving additional support and advice to the reports rendered on some 8,000 
surgical specimens received. A total number ol 44S autopsies were perlormed (May 1, 
19S6-May 1, 1957\ While some of the microscopic studies have lagged because of 
excessive teaching and surgical patholog\- loads, the majority of these autopsies have 
been completed. 

Consultative services in dermatopathologv were made available during the year 
through the appointment o[ Dr. Francis Hllis as Chiel Consultant in Dermatopathologv. 
Dr. Ellis has met with the Stall weekly to discuss ]iertinent problems. Consultative 
services in the operating room have been maintained on a 6 day a week basis. C^on- 
sultative serv ices hav c been made a\ ailable to the lumor Board through representation 
in the Department. 

The Div ision of Nein"Oj"»athologv has examined and rejxirted some 586 specimens 
with an av erage of about 20 surgical specimens per month, the remainder being outside 
consultations or autopsies. 

B. The appointment of l^r. Francis Fllis as Assistant Professor of Pathology in 
Dermatopathologv was announced (^sec above). Dr. Russell S. Fisher and his staff 
were reorganized as a Div ision of Forensic Pathology. Dr. Fisher retained his personal 
appointment as Proiessor of Legal Medicine; however, the remainder of his stalf were 
translerred to the Department ol Patholog\', many with well earned promotions. 

Througb the efforts of the M.nvhunl Division of the American Cancer Society and 
also with support through a federal teaching grant. Dr. John K. Frost of the University 
of California was ajipointed /Vssociate Proiessor of Pathology and in \dvember 1956 
began the organization of the Division of Cvtopathologv. The |ii inic leaching objectives 
included the training of technicians and pathologists with added emjihasis on resident 
and medical student training in cytology. Dr. Frost also assumed sujiervision of the 

105 



106 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

C\ topathologv Laboratory. Se\'en months thereafter, the laboratory examined and 
reported some 3,500 specimens. The School of Exfoliative Cytology for technologists 
was immcdiatelv established, accepted its first full class in January and graduated 6 
students in June. 

lnno\ations included the installation of a Verifax machine for duplicating records 
and the institution of snap sheet report forms for surgical pathology. 

A Di\ ision of Experimental Pathology for medical students was organized through 
good offices of the dean and under the direction of Dr. Lester Kiefer. The Division of 
Experimental Patholog\' functioned through a grant from the National Fund for 
Medical Education to the extent of some S6,000.00, mostly spent in the acquisition of 
basic experimental equipment. 

The processing of routine autopsv material was removed from the General Histology 
Laboratory and was given to one technician as a full-time responsibility. The institution 
of special stains and some basic histochemical techniques was accomplished. 

C. It was impossible to organize any definiti\'e research because of an overwhelming 
load of routine service pathology and the necessity of creating an entire new under- 
graduate pathology curriculum in the midst of a changing department and with 
numerically inadequate personnel. In the category of research, however, one might 
include papers published during the year 1956-57 which are listed and appended 
hereto. '^ Members of the department participated in the following medical meetings: 
American Medical Writers Association; The Texas Cancer Conference; The Annual 
Meeting of the American Medical Association; First Pan-American Cancer Cytology 
Congress; The International Academy of Pathology; The Society of Pathologists 
and Bacteriologists; A Pxcgional Conference on Forensic Pathology in Philadelphia; 
The Annual IVIeeting of the Richmond County Medical Society, Augusta, Georgia; 
The Annual Meeting of the Maryland Society of Medical Technologists; Monthly 
meetings of the Maryland Society of Pathologists; Monthly meetings of the Pathology 
Section of the Baltimore City Medical Society. 

Research in progress includes "Studies on the Pathology of the Cerebellum", "The 
Relationship between Parathyroid Degeneration and Intravascular Pigmentar}' Changes 
in the Basal Ganglia"; investigations are also in progress on "Cardiac Glycogen Storage 
Disease in Siblings". A number of projects are being instituted in the Division of 
Cytopathologv. 

D. The task of completely reorganizing and presenting a curriculum for second year 
medical students was the primary objective of the Staff. A final evaluation of the 

1 Papers Published 1956-57. 

Nagel, L. R.; Wagner, J. A.: Venous Angioma as the Cause of Cerebellar Apoplexy: Report 
of a Case, Bull. Sch. of Med., Univ. of Md., 41: 64-69, Apr. '56. 

Wagner, J. A., et. al.: The Problem of Cerebral Phlebodirombosis; and Analysis of 22 Cases, 
Bull. Sch. of Med., Univ. of Md., 41: 95-108, Apr. '56. 

Wagner, J. A.; Sharrett, J. C: Ischemic Hypophyseal Necrosis and Other Pituitary Lesions: 
Incidence in a Moderately Large Autopsv Series, Southern Med. J., 49: 671-678, July '56. 

Slager, U. T.; Wagner, J. A.: The Incidence, Composirion and Pathological Significance 
of Intracerebral Vascular Deposits in the Basal Ganglia, J. of Neuropath. & Experimental Neurology 
XV: 417-431, Oct. '56. 

Slager, U. T.; Kelly, A. B.; Wagner, J. A.: Congenital Absence of the Corpus Callosum; 
Report of a Case and Review of the Literature, New Eng. J. of Med., in print. 



DEPARTMENT OF PEDIATRICS 107 

problem concluded with a curriculum divided into two portions, the first half year 
presenting the basic problems of disease and tissue reactivity. The second half of the 
year concerned systemic pathology and with special consideration of the broader 
aspects of the fundamentals presented in the first semester. 

The schedule of lectures and demonstrations is attached. The curriculum was 
divided into four basic spheres. The first series of lectures was to orient the student in 
his thinking; next, a set of histologic preparations to show the details of the pathologic 
problem. These were presented, supported by prepared lantern slides and were carefully 
described. A third portion of the curriculum dealt with the presentation of illustrative 
gross material to support the first two facets. Lastly, the Division of Experimental 
Pathology served to bring into focus the dynamic aspects of the processes under con- 
sideration in the curriculum. In addition, students were urged to read extensively on 
their own. A list of approved texts and monographs was provided. Each student was 
required to witness twelve autopsies in the University Hospital and to present a written 
discussion of any six as a prerequisite for admission to the final examination. Frequent 
"progress examinations" were given with the weak students being personallv inter- 
viewed and their problems discussed with a member of the Faculty. A comprehensive 
oral and practical examination was planned but was not given because of personnel 
shortage. 

As a result of extensive and varied requirements of this curriculum, it was felt 
advisable to bring to the students certain experts and other support personnel who 
might serve to strengthen the basic curriculum. These included the following: (1) Dr. 
Henrv C. Feimuth, Toxicologist, Chief Medical Examiner's Office, (2) Dr. Richard 
Lindenberg, Neuropathologist to the Chief Medical Examiner's Office (head trauma), 
(3) Dr. Russell S. Fisher, Dr. Paul Guerin and Dr. William V. Lovitt, Jr. on general 
aspects of forensic pathology, (4) Dr. Charles Wisseman, the relationships of im- 
munologic reactions to disease, (5) Dr. Louis C. Gareis, obstetric pathologv, (6) Dr. 
Llewellvn Ashburn, pathology of the biliary svstem and liver, (7) Dr. Carl T. Tessmer, 
the pathology of radiation, (8) Dr. Chapman H. Binford, the pathology of mycoses 
and the exotic diseases, (9) Dr. Tobias Weinberg, the pathology of sensitization and 
the "collagen diseases", (10) Dr. Mvron S. Aisenberg, D.D.S., three lectures on oral 
pathology of importance to the physician, (11) Dr. F. K. Mostofi of the Armed Forces 
Institute of Pathology spoke on the subject of diseases of the genito-urinarv tract, (12) 
Dr. William S. Stone, Dean of the School of Medicine, delivered the principal lectures 
on parasites. 

We are also indebted to Doctors Donald Mark, Robert Solomon, Carl F. Mech. 
Conrad Acton, Thomas F. Conner, J. M. Ramscv and Milton S. Sacks for assistance 
in the development of the curriculum. The Sub-Department of Neuropathologv took 
a unit of 8 lectures and demonstrations in the central nervous svstem with the able 
assistance of Doctors August Kiel, Robert Moore and Richard Lindenberg. One inter- 
departmental seminar with the Dixision of Neurologv was presented on the subject of 
muscular d\strophv. 

Clinico]iathologic conferences for members of the junior and senior classes were 
given weekly. 

The Department also cooperated with the Department of Ph\ sical Therapv in the 



108 Bl]LLETl?< OF THE SCHOOL OF MEDICINE, U. OF MD. 

presentation of a fundamental orientation eourse in pathology covering 40 lectures. 

CONCLUSIONS 

The appointment of Dr. Harlan I. Firminger as Professor of Pathology will no 
doubt ser\e to crystallize many of the uncertainties of the past year and his advent u'ill 
mark the beginning of the second phase in the curriculum redevelopment begun during 
this fiscal \ear. The de\elopment of a sound research program integrated with addi- 
tional teaching facilities and with a division for pathologic ser\'ice seems most desirable. 
Special pathology such as dermatologic, cytologic and ophthalmic, should certainly be 
emphasized and most certainly will receive Dr. Firminger's prompt attention. 

I wish to acknowledge the contributions of Doctors Kiefer, Gillotte, Slager, Baer, 
Burkart and Tallev to the stability of the academic program and to the efficient main- 
tenance of a service facility which, in the absence of such attention, diligence and 
devotion, would ha\e been an impossibility. The services of Miss Loretta Hogan and 
Miss Joan Hodnick, secretaries, have been both meritorious and are acknowledged with 
thanks. The application and excellent performances of Mr. Louis Jager and Mrs. Anna 
Diver Bunn of the technical staff are especially acknowledged. 

Plans now in progress for the coming year include a broadening of service in 
cytology, residencies and fellowships in cytology and a training course in cytopathology 
for pathologists. The sub-department of neuropathology has in progress three research 
projects and is in the process of de\'eloping a postgraduate course for pathologists and 
an electixe course for medical students. Cooperation with the Divisions of Neurology 
and Neurologic Surgery continues as in the past with postgraduate training, weekly 
classes, seminars and conferences. 



DEPARTMENT OF PEDIATRICS 

I. General Statement of 0-perating Plan and Ideology 

Pediatrics is of Greek derivation and means "child cure." This term seems archaic 
in that it does not describe accurately the function and activity of a modern pediatric 
department. The term "department of child care" would seem to be a truly descriptive 
term. 

Under-graduatc and graduate students need to be taught awareness of the precious 
role of the child in society and their responsibility in safeguarding the physical, emo- 
tional and mental heath as well as to recognize and treat illness in the child. 

It is essential to the very life of a university department that inquiry into the cause 
and nature of all things affecting the child be constantly encouraged and maintained. 
Research is an integral part of our departmental soul. 

A department of child care, which confines its responsibility to the teaching of 
assigned students is remiss in its total function. The child is a member of the com- 
munity and the department must be constantly active in furthering the education of 
all personnel concerned with child care and bringing about impro\'ement wherever 
possible. 

Essentially, the department is concerned with the welfare of the child. The ex- 
pression of this concern has developed into a program designed to teach students com- 
prehensi\'e understanding of the child: to conduct basic and clinical research: to effect 
improvements in general child care throughout the community and to pro\'ide optimal 
services to the child. 

II. Facility and Staff 

J. Edmund Bradley, Professor of Pediatrics and H^ead of the Department 

Ruth W. Baldwin, Assistant Professor of Pediatrics and Director of the Pediatric Seizure 

Clinic 
Samuel P. Bessman, Associate Professor of Pediatrics 
Anna Martha Besterbreurtje, Assistant Professor of Pediatrics 
Melvin N. Borden, Instructor in Pediatrics 
Lester Harold Caplan, Instructor in Pediatrics 
Thomas A. Christensen, Instructor in Pediatrics 
Raymond L. Clemmens, Instructor in Pediatrics and Director of the De\elopmental 

Clinic 
Grange S. Coffin, Instructor in Pediatrics 
Joseph M. Cordi, Instructor in Pediatrics 
Robert M. N. Crosby, Instructor in Pediatrics 
Garrett E. Deane, Instructor in Pediatrics 
Leon Donner, Assistant in Pediatrics 
Edward G. Field, Instructor in Pediatrics 
Jerome Fineman, Assistant Professor of Pediatrics 
Abraham Harry Finkelstcin, Associate Professor of Pediatrics 
Kurt Glaser, Assistant Professor of Pediatrics 

109 



no BULLETIN OF THE SCHOOI OF MEDICINE, IJ. OF AID. 

Samuel S. Glick. Assistant Professor oF Pediatrics 

Howard Goodman, Instructor in Pediatrics 

Martin K. Gorten. Instructor in Pediatrics 

Mary L. Hayleck, Instructor in Pediatrics 

Frederick Joseph Heldricli, jr., Instructor in Pediatrics 

Glewell Howell, Associate in Pediatrics 

Da\id Josephs, ^Assistant in Pediatrics 

C. Loring Joslin, Professor of Pediatrics 

John M. Kragcr, Assistant in Pediatrics 

Arnold F. La\'enstein, Instructor in Pediatrics 

G. Bowers Mansdorfer, Associate in Pediatrics 

Marv E. Matthews, Assistant in Pediatrics 

Israel P. Meranski, Instructor in Pediatrics 

William A. Niermann, Assistant in Pediatrics 

Leonard Scherlis, Instructor in Pediatrics 

Sidney Scherlis, Associate in Pediatrics 

William M. Seabold, Assistant Professor of Pediatrics 

Ilenrv Murra\' Seidel, Instructor in Pediatrics 

Fred. B. Smith, Associate Professor of Pediatrics 

Melchijah Spragins, Associate in Pediatrics 

Oliver Walter Spurrier, Assistant in Pediatrics 

Alvin A. Stambler, Assistant in Pediatrics 

Arnold Tramer, Instructor in Pediatrics 

William Earl Weeks, Assistant in Pediatrics 

Gibson Jackson Wells, Assistant Professor of Pediatrics 

J. Carlton Wich, Assistant in Pediatrics 

House Staff 
Daniel Anderson, Intern 
Edwin Besson, Assistant Resident 
Robert W. Gibbes, Assistant Resident 
William Hatfield, Assistant Resident 
Murray Kappelman, Assistant Resident 
Ke\in F. McCaul, Assistant Resident 
Marx'in S. Piatt, Intern 
Inge Renner, Intern 
Karl Weaver, Assistant Resident 
Francis Winslow, Assistant Resident 
Robert E. Yim, Assistant Resident 
Arnold Vance, Resident-in-Chief 

III. Teaching 

The department teaches medical students assigned to the department within the 
unit system of the school curriculum. Third vear students spend six weeks in the 
department as in-patient clinical clerks. One-third of each group is assigned to the 
pediatric di\ision of the Mercv Hospital, the remainder to the llnixersitv Hospital. 



DEPARTMENT OF PEDIATRICS 111 

The plan of teaching is to use small groups ot students with instructors and through 
free and broad discussion to encourage the students to learn. 

During the fourth year the students are assigned to the out-patient areas of the 
University Hospital for a four week period, where the same philosophy of teaching is 
maintained. 

The department also teaches physical diagnosis to second year medical students 
and participates in correlati\'e teaching in the second Near as well as interdepartmental 
seminars of the third and fourth years. 

The School of Nursing carries on a broad teaching program within the Pediatric 
Department under the able direction of Dr. G. Sellew, Professor of Pediatric Nursing, 
Faculty Members of the Pediatric Department are utilized in this phase of teaching. 

IV. Re^earcli 

The following grants-in-aid totaling $173,980 received to support research and 
educational actixities in the Department of Pediatrics. 

DR. RUTH BALDWIN 

U. S. Children's Bureau. . .SI0,000 Maryland Epilepsy Program 
^National Institute Health. . 15,354 Effectixeness of 1-Asparagine in the control of 

seizures 
* Joint grant with Dr. Charles Van Buskirk, Professor Neurology. 

DR. S. P. BESSMAN 

Bresslcr $ 6,480 

American Cancer Society. . 6,000 Formation and utilization of gamma hydroxy 

butyric acid by brain 

Public Health Service 41,500 Brain metabolism and systemic disease 

National Cystic Fibrosis 

Foundation 5,750 

Eli Lilly Co 5,347 Role of insulin in integration of enzyme 

s\stems 

DR. J. E. BRADLEY 

National Institute Health. .$15,330 Lead Intoxication 

Mead Johnson Co 500 Resident Education 

Children's Bureau 6,000 Premature Program 

Mental Hygiene Societv 

Greater Baltimore 20,000 For support of Mental Hygiene Society Child 

Guidance Clinic administered jointly by 
Department of Pediatrics and Psvchiatrx 

DR. J. E. BRADLEY AND R. L. CLEiMMENS 

Public Health Service S 6,095 Role of ammonia in lethargic state in newborn 

infant 



112 BVLLETl>; OF THE SCHOOL OF .MEDICINE, 11. OF MD. 

DR. J. E. BRADLEY AND G. COFFIN 

Eli Lilly $ 3,000 Penicillin evaluation 

DR. M. GORTEN 

Public Health Service S 5,590 Blood ammonia le\el in er\ throblastosis fetalis 

DR. E. C. LAXTVE 

Plavtex Park Research Inst.. $19,042 

Public Health Service 7,992 1 erminal respiration in azotobacter vinelandii 

The following research projects are in progress in the department: 
Studies of effect of benadrvl. dilatin and reserpin on behaxior of children with organic 

brain damage and behavioral disturbances 
Comparison of experimental medications in seizure control 
Mechanism of insulin action 
Mechanism of ammonia poisoning 
Amine metabolism in liver disease 
Studies in cvstic fibrosis 
Gastric content ammonia le\ els in newborn 
Sweat and saliva electrolvte le\ els in newborn 
Cardiac glvcogen storage disease 

Hvperbilirubinemia in neonates and indications for exchange transfusions 
Study of the anemia of chronic infection 
Micro serum bilirubin determinations 

Effectiveness of glutamine antagonists in acute leukemia of children 
Placental immunits* 

Blood lead levels according to socio-economic lexels 
Tetra-ethyl lead intoxication 
Effect of lead on mental development 

V. Graduate Program 

The department participates in the training of rotating interns, general practice 
residents and pediatric residents. Interns and residents from the Mercv, Church Home, 
St. Josephs. St. Agnes, Lutheran and Marine Hospitals recei\e their training in 
pediatrics at the LIniversitv Hospital. Requests from other hospitals were recci\ed, 
however, but because of limited facilities thev could not be honored. Inclusi\e of the 
interns and residents of the Unixersitv Hospital, there were 69 interns and residents 
trained. The program is fullv approved by the American Board of Pediatrics and the 
Council on Hospitals and Education of the American Medical Association. Approval 
from parent certifying boards is also held bv the following clinics in the department: 
Seizure, Child Guidance, Cardiac. 

Ten physicians and Fellows were trained in the laboratory under the direction of 
Dr. Samuel P. Bessman. These men and women were from other medical schools as 
well as from our own school. Four medical students carried on \arious research projects 
under Dr. Bessman. 



DEPARTMENT OF PEDIATRICS 113 

The Mental Hygiene Society Child Guidance Clinic under the moderation of Dr. 
Kurt Glaser, Assistant Professor of Pediatrics, continued their monthly evening sessions 
with practicing physicians. These sessions are devoted to discussion of common emo- 
tional problems of children, e.g., school phobias. This clinic has, within the past vear, 
had three graduate physicians training in the clinic: two of these are from Israel and 
one is of local origin. 

Two medical students carried out Summer projects under the direction of Dr. 
Raymond L. Clemmens. 

On March 29 and 30, 1957, a scientific svmposium on "Consciousness and the 
Chemical Environment of the Brain," was held. It was sponsored by the Ross Labora- 
tories and ably organized by Dr. Samuel P. Bessman. This symposium was attended 
by 100 outstanding investigators from the United States, Canada, England and 
Puerto Rico. 

The Sixth Annual Pediatric Seminar was held on March 31, 1957. This Seminar 
is designed to present to practicing physicians significant current advances in pediatrics. 
The Chairman, Dr. Frederick Heldrich, and his committee arranged for presentations 
bv outstanding speakers from Boston, New York, Buffalo and Philadelphia. The 
Seminar was attended bv 227 physicians from Maryland and adjacent states. 

VI. Statistical Analysis Work Done and Service Rendered 

There were 34,000 infants and children seen in the out-patient clinics of the 
Pediatric Department during the fiscal year, 1956-57. This represented an increase 
patient load of 2500 over the preceding year. Increases were particularly noticeable in 
the pediatric emergency room and in the general pediatric clinic. Special clinics such 
as Child Guidance, Cardiac, Well-baby and Seizure showed increases, but not as 
marked as in the above mentioned areas. 

The increased load has added additional strain to already overly burdened and 
inadequate facilities. 

A total of 1386 infants and children were hospitalized in the Pediatric Department, 
University Hospital. During 8 of the 12 calendar months the in-patient department 
operated at a 90 per cent occupancy. This resulted in many patients, in need of hospital 
care, receiving such care through being maintained in our crowded emergency room 
for a varying number of hours. Many patients were referred to other hospitals while 
the majority were treated on an ambulant basis. There exists a critical need for more 
hospital beds for children. The effort to treat many of our sick children coming from 
a low socio-economic Icxcl on an ambulant basis means that they are too often depri\ cd 
of the constant, intelligent superxision necessary to restore them to health. 

The Pediatric Department has the responsibility of giving pediatric care to the 
infants born in the LIniversity Hospital. Last year there were 2617 infants born. 

The Premature Nursery is also under the direction of this department. In addition 
to providing care for those premature infants born at the Unixersity Hospital, it also 
receives infants born at other hospitals or those born outside the hospital, since this is 
one of the premature centers in the State. A total of 201 premature infants receixed 
care in our nursery during the past year. 



114 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF AID. 

VII. Facilities and li(iiiipuiciit 

Square footage— 26,400. 

The Department of Pediatrics is located on the 5tli floor of the University Hospital. 
Currently it is allocated 96 beds, however, 26 of these beds were used for a temporary 
premature nursery. There are seven private rooms, with the remainder divided into 
four bed cubicles, each unit being subject to isolation. Patient beds, classroom, play 
areas and offices for the full-time professor, associate and assistant professors, as well as 
offices for the pediatric nursing professor and instructor are located on this floor. The 
Department of Pediatrics is responsible for the newborn and premature nurseries on 
the 6th floor (2,168 sq. ft.) with a total of 81 bassinets. Animal facilities are in the 
Bressler Building. Out-patient facilities are in the basement on the first floor of the old 
Out-patient Department (OPD) building. Research laboratories are housed in two 
rooms on the fifth floor with two small additional laboratories, one in the OPD and 
one in the Bressler Building. 

VIII. Coiiiuinnity Activities 

Members of the Department of Pediatrics participated in numerous acti\'ities 
throughout the community. A partial list of activities of members follows: 

NON-SCIENTIFIC PAPERS 

Dr. R. Baldwin 

Epilepsy-Types of Patients for Residential Care: Silver Cross Home for Epileptics; Kings Daugh- 
ters: Reisterstown, Maryland. 

Correlation of Medical and Educational Facilities for Retarded Children: Salisbury, Maryland. 

Advisability of EEC Laboratory and its Applications: Board of Directors, Peninsula General 
Hospital: Salisbury, Maryland. 

Epilepsy: Mothers Club of Rogers Forge School, Baltimore, Maryland. 

Dr. S. P. Bessman 
Cystic Fibrosis-A Chronic Disease of Childhood: TV-MD, WBAL. 

Dr. J. E. Bradley 

The Role of the Child Guidance Clinic in Teaching: 

Woman's Auxiliary, Baltimore City Medical Society, Baltimore, Maryland 

Lead Poisoning in Children: National TV-NBC, New York City; National TV-CBS, New York 

City; National Radio, Mutual, New York City; Radio, Local stations. New York City; National 

Radio, CBS, New York City. 
Poliomyehtis Vaccination: TV-WMAR, Baltimore; Radio, WBAL, Baltimore. 
Mental Health: Radio, WCAO, Baltimore. 

Dr. R. L. Clemmens 

Polio Prevention: TV- WBAL, Baltimore. 

Guard your Health Month: Radio, "U'CAO, Baltimore. 

Dr. K. Glaser 

Pre-school Child and Delinquency: Governors Conference, College Park. 

Behavior Characteristics of the Pre-school child: PTA of Kindercraft Kindergarten. 

The Emotionally Healthy Child and How to Keep Him So: Child Study Association of Baltimore. 



DEPARTMENT OF PEDIATRICS 115 

The Adjustment of Handicapped Children: Association for Handicapped Children, Annapolis, 

Maryland. 
How to be Effecti\e Parents: Women's Club of Johns Hopkins University. 
What Children can Benefit Most from Attending the Children's Guild?: Directors of Baltimore 

Nursery Schools, Baltimore. 
What is the Nature of the Trainable child?: Maryland Society for Mentally Retarded Children. 
Pre-school Problems: Children's Guild, Baltimore. 
Children's Anxieties: PTA of P.S. 241, Fallstaff. 
Mental Health and Prejudice: B'nai B'rith Womens Lodge. 
The Father's Role in the Family: North West Cooperative Preschool Group. 
When a Teacher has a Problem Child: State Teachers College, Towson, Maryland. 
Sex Education of Children of Elementary School Age: PTA of P.S. 210. 
Children's Guild, Inc. Discussion Groups: The Negativistic Phase; Jealousy; Spoiling; Spontaneous 

Discussions. 

Dr. S. S. Click 

Your Child and You: PTA-Beth Jacob School. 
Your Child and You: Shaarei Zion Sisterhood. 

Dr. M. Gorten 

Modern Treatment of Nutritional Anemia: University of Maryland Alumni: Telecast. 

The department maintains a Poison Control Center, which enables physicians or 
parents to obtain information and management regarding harmful substances which 
may have been ingested, inhaled or have come into contact with the body surface. 

Membership on local, state and national committees is listed below. The variety of 
committees indicates the wide interest which the department maintains in all phases 
of child welfare. 

Dr. Ruth W. Baldwin 

Medical Advisory Board of State of Maryland (Department of Motor Vehicles). 
Subcommittee on Medical Services for Handicapped Children in Maryland. 

Dr. J. E. Bradley 

Council on Medical Care, State of Maryland. 

Consultant, Baltimore City Department of Health. 

Maternal and Child Welfare, Medical and Chirurgical Faculty, Chairman, Pediatric Section. 

Central Coordinating Committee on Poliomyelitis Vaccination, Medical and Chirurgical Faculty, 

Chairman. 
Advisory Committee Distribution of Salk Vaccine, Medical and Chirurgical Faculty, Chairman. 
State Department of Health Committee on Distribution of Salk Vaccine, Chairman. 
Board of Directors, St. Francis School of Special Education. 
Board of Directors, Mental Hygiene Society Greater Baltimore. 
Board of Directors, Children's Guild. 
Teaching Consultant, U. S. Army, Aberdeen. 
Chief of Pediatrics, Provident Hospital. 
Chief of Pediatrics, Lutheran Hospital 

Consultant Pediatrics, Kernans Hospital for Crippled Children. 
Consultant Pediatrics, South Baltimore General Hospital. 
Maryland State Planning Commission, Committee on Medical Care, Subcommittee on Medical 

Services and Facilities for Handicapped Children in Maryland. 
Subcommittee on Diagnostic and Evaluation Centers for Handicapped Children. 
Subcommittee on Mentally Retarded Children. 



116 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

Regional Committee on Pediatric Education, American Academy of Pediatrics. 

Standardized records of maternal and neonatal statistics, Academy of Obstectrics-Gynecology, 

Academy of Pediatrics, Childrens Bureau support by grants-in-aid. 
$35,000 Josiah Macy Foundations, Childrens Bureau $50,000 to State Department of Health of 

Connecticut; Executive Committee. 
Medical Advisory Board, Notre Dame College. 

Dr. R. L. Clemmens 

Advisory Committee, Maryland School for Mentally retarded. 
School Physician, St. Francis School of Special Education. 

Dr. K. Glaser 

Heart Association of Maryland, Public Education Committee. 

Maryland State Planning Commission. 

Committee on Medical Care, Subcommittee on Medical Services and Facilities for Handicapped 

Children. 
Maryland Commission for the treatment and prevention of Juvenile Delinquency. 
Committee on Health and Delinquency, Baltimore Parent Education Council. 
Subcommittee on Classes for Parents of Infants. 
Committee on Juvenile Delinquency of Maryland, Chapter American Academy of Pediatrics, 

Chairman. 

Dr. S. S. Click 

Chairman Pediatric Section, Baltimore, City Medical Society. 

Student Loan Fund, Phi Delta Epsilon. 

Medical Fraternity, Chairman. 

Tau Alpha Omega Fraternity Convention, Chairman. 

1. Baldwin, R. W.: The new and old in the treatment of epilepsies, J. Am. Med. Womens 
Assoc, August, 1956. 

2. Bessman, S. p.: Preparation and assay of oxalacetic acid. Methods of Enzymology, 111. 

3. Bessman, S. P.: The relation of the krebs cycle of clinical diseases. Bull. Sch. of Med., Univ. 
of Med., 41: 1, 1956. 

4. Bessman, S. P.; Shear, S. and Fitzgerald, J.: The effect of arginine and glutamate on 
the removal of ammonia from the blood in normal and cirrhotic patients, New Eng. J. Med. 
(in press). 

5. BoRGEs, F. J. and Bessman, S. P.: Serotcjnin, Ann. of Int. Med., 46: 2, February, 1957. 

6. BoRGES, F. J. and Bessman, S. P.: Urinary excretion of 5-hydroxyindole acetic acid, a 
serotonin metabolite in hypertensive renal-vascular disease, Soc. Exp. Biol, and Med., 93: 
513, 1956. 

7. Bradley, J. E.: The comparison of BAL (2,3-dimercaptopropanolj and CaEDTA (calcium 
ethylene diamine tetra acetate) in the treatment of lead encephalopathy, A. J. Dis. Child., 
Proc. Amer. Ped. Society. 

8. Bradley, J. E. : Don't let your child get lead poisoning, Parade Magazine, July 22, 1956. 

9. Bradley, J. E. and Bessman, S. P.: Poverty, pica, poisoning, U. S. Pub. Health Reports 
(in press). 

10. Bradley, J. E. and Menon, C: Regurgitation in infants. South. Med. J., 49: 1317, 1956. 

11. Clemmens, R. L. : Salivary chlorides in the first year of life. Am. J. Dis. Child., January, 
1957. 

12. Clemmens, R. L. and Bessman, S. P.: The ammonia content of the gastric juice in the 
newborn infant, Proc. Soc. Ped. Res., June, 1957. 

13. Clemmens, R. L.; Shear, S. and Bessman, S. P.: Blood ammonia in newborn infant. 
Submitted for publication in Pediatrics. 

14. Glaser, K. and Eisenberg, L.: Maternal deprivation, Pediatrics, 18: 636, 1956. 



DEPARTMENT OF PEDIATRICS 117 

15. Click, S. S.: The Herman Seidel story, Phi Delta Epsilon Med. Frat. Mag., 1956. 

16. GoRTEN, M. K. and Jahn, E. F.: Hemolytic disease of the newborn due to anti-w right 
(Wr<'0, Pediatrics (in press). 

17. GoRTEN, M. K.; Shear, S.; Hodson, M. and Bessman, S. P.: The complications of hvper- 
bihrubinemia in the newborn and their possible relation to the metabolism of ammonia. 
Pediatrics (in press). 

18. Leikin, S. and Bessman, S. P.: The effects of various EDTA complexes on coagulation. 
Blood, 11: 10, 1956. 

19. Patterson, P. R.: Lipton, E. L.; Unna, K. R. and Glaser, K.: Dosage of drugs in infants 

7 7 7 7 7 7 O O 

and children, III Neostigmine, Pediatrics, 18: 31, 1956. 

20. Shane, S. and Glick, S. S.: Anaesthesia for Frankie, F. A. Davis, 1956. 

In addition to the preceding list of publications, scientific papers were presented 
by members of the department. They were as follows: 

Dr. R. W. Baldwin 

Workshop of Epilepsy: National Epilepsy League, Inc., Syracuse, N. Y. 

Medical Aspects of Epilepsy: International Council on Exceptional Children, Pittsburgh, Pa. 

Panel member of Symposium "What is the Nature of the Retarded Child?": Maryland Society 

for Mentally Retarded Children, Inc., Baltimore, Maryland. 
Series of talks on Epilepsy: 

Members of the staff of Rosewood State Training School, Owings Mills, Maryland. 
Public Health Nurses, Southern and Western Health Districts, Baltimore, Maryland. 
Public Health Nurses, Prince George's County. 

Practical Nursing School Class, Prince George's County General Hospital. 
Members of the staff of the Spring Grt)ve State Hospital, Catonsville, Maryland. 
Epilepsy in Public Health Work: Johns Hopkins Hospital School of Hygiene and Public Health, 

Baltimore, Maryland. 

Dr. S. P. Bessman 

The Effect of Glutamic Acid Therapy on Mental Deficiency: A Four Year Study on Out-patients, 

American Association on Mental Deficiency, Richmond, Virginia. 
Factors Affecting the Appearance of Ammonia in the Gastric Juice: American Society for Clinical 

Investigation. 
The Ammonia Content of the Gastric Juice in the Newborn Infant: Society for Pediatric Research, 

California. 
Estimation of Citric Acid and Ketone Bodies by the Salicyaldehyde Acetone Reaction: Federation 

of Biological Sciences. 
Biological Aspects of Mental Disease: AAAS Symposium on Mental Disease. New York City. 
The Clinical Significance of Blood Ammonia: Physiological Chemistry Seminar, Mount Sinai 

Hospital, New York. 
Etiologic Factors in Mental Retardation: Participant in Ross Symposium, Chapel Hill, North 

Carolina. 
Consciousness and the Chemical En\ironment of the Brain: Ross Symposium, Chairman, Uni- 
versity of Maryland Hospital. 
Course of Basic Neurology: 3 Lectures, Medical Students, George Washington University. 
Recent Advances in the Understanding and Treatment of Diabetes: Frederick County Medical 

Society, Frederick, Maryland. 
Ammt)nia Metabolism: 1 bird Year Medical Students, Georgetown LIniversity Medical Center. 
The Chemical Phenomena Associated with Clinical Ammonia Poisoning: Seminar in Biological 

Chemistry, Johns Hopkins School of Hygiene and Public Health. 
Hepatic Coma: Panel on Hepatic Coma, American College of Physicians, Boston. 
Carbohydrate Metabolism: Department of Pediatrics, City Hospital, Baltimore, Maryland. 
Serotonin Metabolism: Department of Medicine, Lutheran Hospital, Baltimore, Maryland. 
Ammonia Poisoning: Endocrine Clinic, Johns Hopkins Hospital, Baltimore, Maryland. 



118 BULLETIN Oi' Till- SCIUK)l O/ MiniilM. U. ()/ MIX 

Di:\. \. r.i.ulloy 

Staphvlococcal Inlcctioiis in C'liililriii. 

Malignaiuios ol C'liilillmoil. 

Status of Salk Wicciiu-. 

Tuberculosis in Cliildhood. 

Clinical Applications of Hlcctrolytcs in Pediatrics. 

Common Emotional Problems in Cbililren: Abenlicn I'loxini; C'.nuunl. 

Stapbylococcal Infections in C'luUlren: C^urnll C'ouniv Mcilicil SocictN. M.ii\laiul. 

Poisoninj^ In C^bildren; Wist \'iii;ini,i l\m I l.iiullc Mcilical Sin.iit\ .iiul .\iailen>y of Ci-neral 

Practice. 
Attending Pediatrician: llanicl 1 .inc I lomc. Johns 1 lupkms I lospit.il, iMmuh nl iXoxcmbcr. 

I )r. I\. I . C Irninu'iis 

Salt Di'plction .is a C i)in[iiication ol an lli'icdilaix |)isiMst'; llni\cisit\ ol Mar\l.iiul 1 lospit.d, 

Medical StaiV. 
Sweat and Sali\a Chlmidc C'dnii'ntraliniis; n.illiinnrc IV'ilialiics lu'scaicli SocicI\. 
Congenital y\noinalies: liallinunc C'il\ I Iiailli 1 Xp.ii tnunl, Western 1 li'aitli Disliicl MnnlliU' 

Meeting. 
The Handicapped Cliilil; Postgi-.idu.itc cmiisi' ol ni.iti'in.il ,iiul child hc.dth. Dcp.irliiunt of 

Obstetrics Nurses. 

l)i. K. Cil.iscr 

Juvenile DelinquencN'. 
Stealing and Lyinjj. 
School Phobia. 

Adolescence; Scientilic sessions for pixli.itrici.ins .iml m'ner.d iM.ictiiioniMs, Mcnt.il ll\gicnc Socict\' 
Clinic for Children. 

Dr. M. K. Clortoii 

Acute Leukemia \n Chiklhood: Peiliatric StalV, LInion Meniori.d 1 lospit.d. 

Aplastic Anemia: Medic;il St.ilf, South lialtimorc Ceneral 1 lospit.d. 

Henoch Schoeidein Purpura: Mcilical St.dl. South Iviltimore Ceneral llospit.il. 

Acute Dissemiii.itcil lupus l'r\'thematosus in Childliood; Pedi.itric St.dl, Union Mcnioii.d llos 

pil.d. 
Aucini.i ol I'lcm.itui il\ , Meilic.d St.dl, South ll.illinion' (Icncr.d llospii.d. 

Management of the i\h Negative Mother and lied Child: Ohstiii ic St.iii, H.dlunoic C'ii\ llospit.ils. 
Treatment of the i'r\ throhl.istotic Inlaut: Pedialiic St. ill, Mcii\ llospit.il. 
Managenunt ol the l'r\ ihidhl.istotic InlanI; Pcdiitiu Si, ill. Union Menioii.il llospit.il. 
Acute Leukemia in Childhood: Meilic.il St, ill, South li.iltimore Cener.il 1 los|iit,il. 
Inin Delicienev Anemia: Mi'dic.il St. ill. South li.iltimore Ci'ikt.iI llospit.il. 
Consciousness anil the Chcinic.il I'lnironmi-ut of the Ur.iiu: ^^ith Peili:ilric Ui'se;iich C^mference— 

Ross Laboratories. U.iltinioie, M.irvkmd, Discussiiut ol "Miliruhin I'nci'ph.dop.itlu ". 
Diiignosis of Neon. II. il |.unulice; ,\ledic.il Si. ill'. South U.iliiinoic (icnci.il Uospii.il. 

Dr. I . C:. I .i\ni> 

Consciousness and the C'hemic;il iMivironnunt ol the liiMiii; 2,^th I'cdi.ili ic lusc.iich ( 'onference— 
Ross Laboratories, Hultimoie, M;ir\l.in(l. Uisiuss.mt ol ".Xniiiioni.i Met.iholisni in the lh;iin". 

X. Hc'coiiniicinldlioiis jai I iiijunii'iiii'iil 

It is obvious liom llir lon'ooini; lli.il this ilrp.ii liiu'iU is n'lulrriiio (.wlciisixo aiul 

sioiiihcaiit tcichiiio. rrsi'.iiih ,iiul si'i\ icr in llic lirM ol rliihl i.iio. Ihis work is lu'iiio 

iliinr with liuiiti'i! .iiul iii.iili'i|ii.iti' l.iiililirs. \i |Mrst'nl iiowiK'il idiiililions iwist in otir 

ri'SLMrch l.ihor.itories, Ir.irlnno, .nul srixiir .iii'.is. 



DEPARTMENT OF PEDIATRICS 119 

Hence, recomnKnchiiions based on departmental committee study are as follows: 

There exists a need to dexelop, within the framework of the Medical School, a 
realistic and complete center for child care, to meet not only the teaching needs of an 
anticipated increased numlKM- of medical students, but to educate and train adequately 
those indi\ickials who will provide service and care for a steadily increasing child 
population (4,800,000 infants born in 1956). 

The dynamic growth and emergence of pediatrics as a special discipline has created 
a significant deficit in the training of phvsicians and nurses assigned to smaller hospitals. 
Hence child care centers must offer, within the center, teaching opportunities for these 
individuals. 

The problems of the adolescent and others either need to be created or are in need 
of urgent lurther dexelopment in teaching, research and scrx'ice in certain pediatric 
specialties, such as ()|ihtlKilmolog\ , cardio-thoracic surgerv, neuro-surgerv, and diseases 
of the nose and throat. 

It is to be recognized that the child is not a ininiatLiic adult, but has diderent 
physical, emotional physiologic, and immunologic problems, all of which need to be 
considered carefully in providing care. The child recjuires a physical environment, 
suitable to his physical si/e and concept of what is familiar and attractixe. Me needs 
an enx'ironment which docs not expose him to emotional trauma, which protects him 
from infection, and where care is proxided by personnel skilled in the management of 
children. 

While the present centinx has witnessed remarkable developments in the pre\ention 
of disease of children, impro\'ed nutritional standards and increased knowledge of 
disease, the need continues for i^romoting and iurthering pediatric research within 
a pediatric center. 

It is recommended that there be created a complete pediatric unit at the School of 
IVIedieinc, LIni\ersitN' ol Mar\land, in which would be housed the lollowing: 

A general pediatric out patient de|xirtment— this would permit the development of 
a strong teaching program through simulating as closeK' as j)()ssible in ph\sical con- 
struction and function the pri\ate practice of medicine. In this unit adequate isolation 
ol patients shoiikl be jM)ssible. "I here should be examining areas eonduci\e to good 
patient api^raisal, areas offering ease of meetings between consultant and student, 
adecjuate instruction areas, and diagnostic laborator\' facilities. Within this unit would 
also be housed a C'liild C Guidance Clinic which is an integral part of the clinic in 
teaching pediatric residents and medical students the recognition and treatment of 
emotional problems of children. There exists, because of the di\ision of medical scrxice 
and specialties ser\ ing the ju'diatric age group ami the adult age group, a need for the 
creation of an adolescent unit. /\djacent to the general |)ediatric out-patient department 
should be created a pediatric emergency room. This imit should be in operation 24 
hours a daw as a screening clinic during the clinic da\ and as an emergency room 
after clinic hours. The jicdiatric emergenc\' room should ha\e an adequate waiting 
area, separate examininci areas, and an obscrxation area. The a\eraoe child is more 
disturbed at the sight of a helpless, in)ined or unconscious adult or a woman in the 
first stages of labor than b\ the sight of an injured or sick child, since he is accustomed 
to rely on adults lor securit\. I he pediatric emeruoncy room, as well as all other areas 



120 BULLETIN OF THE SCHOOL OF MEDICINE, II. OF AID. 

of the pediatric unit, should be so constiucted that the child is not exposed to these 
forms of emotional trauma. 

A Central Exaluation and (.uitlance C-linic lor I landicappcd Children. ,\ report 
bv the Professor and I lead oi the Department ol Pediatrics on this problem to a 
committee of the i\hir\ land State Planning C'ommission on Medical Care, studying the 
problems of the handicajiped child, states; " The present centmx' has witnessed the 
conquest and control ol man\ inlections, nutrilional and en\ iroiinicnlal diseases. Ihesc 
ad\'anecs ha\e jxiralleled the de\'elopment ol strong teaching and research |:)r()grams 
bv medical schools in these areas. I I()v\e\er, during the same j)eriod relatixelv little 
attention has been gi\en b\ the medical schools to the problems ol the handicapped 
child. The recognition, counseling and care ol these children has been assumed by 
\()lLnitar\' agencies, the |)ublic health dejxu-tmcnt, and the occasional medical school 
clinic. These organizations ha\e interested themscKes in s|X"cilic handicaps, without 
considering carefulK the total medical, social, psvchologic and educational needs of the 
child. Ihe child has been treated in parts, jiarticularlv that part which is most involved, 
such as orthopedic, hearing, \'ision or speech and then lor special s\ mptoms as epilej'jsv, 
cerehral |:)als\ or emotional disturbances. The teaching of undergraduate and graduate 
medical students, as well as key ancillary personnel, has also been in this xertical 
manner." 

An additional consecpience of the above trend has been the development of rc- 
strieti\'e research. Indixiduals, interested in a s|)eciric handicap, ha\e organized them- 
scK'es into groups and raised sums of moncN to pro\ ide scr\ ice and research in the 
speciHe handicap. While signiheant advance has been made in certain areas through 
this approach, flexibility to encourage and to develop investigation into promising 
unrelated, vet significant areas, is missing. 

It seems obvious that a need exists to j^rovide facilities to leach, within medical 
schools, the recognition and consideration of all the needs of handica|)|)ed children and 
to apply these principles to improve the service to them. Solution to these deficits would 
seem to lie in the creation, within medical schools, of an cxaluation center for handi 
capped children. 

In planning such centers the following points shoidd be considered: 

1. Ceographic, separate location in a ncv\' unit or in an existing imit clearl\- 
designated lor this ])urpose. 

2. The unit should be under the direction of a person who has understanding of 
total child needs, j:)referablv a ]:)ediatrician. 

3. Immediate additional key personnel would consist of a social worker and a 
psychologist. 

4. Medical students, I ellows, housf oditris and medical practitioners would he 
assigned to the clinic. 

5. Intake of patients would be by referral from recognized agencies and professional 
persons. 

6. Patients admitted to the center would ha\e a comjilete medical, social, and 
psychologic appraisal. 

7. A|:)praisal of each handicap would be obtained from an appropriate specialist. 

8. The director would arrange a group discussion of all concerned personnel for 



DEPARTMEST OF PATHOLOGY 121 

consideration of the indi\ idiuil. medical treatment, social, psychologic, educational and 
dispositional needs. 

9. Consideration shoukl he gi\en to the use ol the medical centers iov the training 
oi: futine teachers ot handicapped children. Expansion ot the present program is indi- 
cated between the Department of Hducation, University of Maryland and the Depart- 
ment of Pediatrics, School of Medicine. 

10. A small number of beds in the Llni\ersitv of Maryland slunild be a\ ailable for 
those children who require a more intensixe in\ estigation. 

1 1. Consideration should be gi\en to the use of existing institutitms, e.g., Kernan's 
Hospital and Children's I lospital School, lor those children requiring long term insti- 
tutional care. There has been a decline of patient admissions to these hospitals, so that 
their future appears uncertain if the\ intend to cimtinue as orthopedic hospitals. 

12. These hospitals should complement the exaliiation centers and the chiklren 
should rccei\ e the same complete t\ pe of care. 

1.^. The centers within medical schools should t miction priniariK as teaching and 
research units. 

14. There should be tormed similar e\aluation centers in certain kc\ rural areas, 
under the direction o\i the State Department o( 1 Icalth. llo\\e\er, there should be a 
close cooperation between the rural center and the me(.lical school center following the 
organization of the present epilepsy program. 

15. This proposal does not enyision a discontinuance ot existing ser\ ice agencies, 
but rather a strengthening and improying of their operation. 

The foregoing en\ision a truly cooperati\e eftort of schools, public health depart- 
ment and community in dealing with the complex and growing problems of the 
handicai->jied child and parent. A successful solution requires the acceptance of the 
basic philosophx and the subsequent cooperation of many indi\iduals. 

This unit would include special pediatric clinics, tentati\e ]">lans w hich ha\e been 
submitted (or the i.le\elo|iment ol such a central clinic. It is to be pointed out that iine 
of the things included on the jMan is a nursery classroom. 1 his would pro\ ide an area 
lor the teaching of indixiduals concerned with the education of the handicapped 
children, at the s.une time it woiikl permit plnsicians to make appraisals ol the special 
needs w hich might be in\ol\ed in teaching these children. Construction of these areas 
should be such, that phxsicians may ha\e their ollices there. I hose who are empkned 
b\ the School ou a geographic jxirt-timc b.isis might be juMniittcd to see pri\ ate patients. 

At the present time, there exists a need to separate hospitalized infants, i^from birth 
lo twii years of age^ from the older children. There is also a need to otler separate 
Licilities lor the pri\ate ami semi priwite |ietliatric patients. It is recommended, that 
there be a children's ^age 2 to 12). surgical and medical hospital iniit of 60 beds, of 
which 1^ bcils WDidd be lor the care of short term hantlicaj'iped chiklren. 1 here should 
be .m inl.nit unit vtip t*^ 2 \ears^ ol ^0 mcilical .\\u\ surgical bctls. Semi-|iri\ ate and 
prixate accommodatiiMis shcndd be j">rt)\ ided lor 5S jxuients. Ten of these beds shoukl 
be set aside in the a(.K>lescent miit hir children ^12 to 16 \ears of age^. These accom 
modatitMis shoidd be cinistructed in such a wa\ as t(^ meet the particular needs ol these 
children. At the same time they are alViMtled the pri\ac\ which their age requires. 

In planning for the in-patient pediatric unit, pro\ision should be made for a 



122 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

number of companion rooms where the mother or substitute ma) stay with child day 
and night. These rooms should be jiro\ ided, not only for private patients, but for those 
service patients whose condition needs mother care or the constant attendance of an 
adult. Cubicles should be of suOicient size to accommodate a bed, bedside table and 
chair. The latter is for the mother so that she may be seated comfortably and hold the 
child on her lap if his condition warrants, or so that she may sit beside him to read 
or to plav with him. In other words the semi-pri\ate ward unit should have space which 
permits as normal a life as possible for the child confined to his cubicle. There should 
be a waiting room for mothers, equipped with such con\'eniences as a place to put 
UTaps, toilet facilities, a drinking fountain, easy chairs and a space where inter\'iews 
between parents and phvsicians can be held. Within each pediatric unit there should 
be adequate admitting rooms, treatment rooms, areas for physical, occupational or play 
therapv. Ideallv, there should be an area where the children may be out of doors; if 
possible, a fenced-in garden or a roof. In the children's area there should be a nursery 
school, dininp room and toilet accommodations, accessible to all areas vvhere\er the 
children mav be. It is to be remembered that the personnel in the children's ward, 
although well prepared for the work, cannot give adequate care to the children unless 
thev are working in a physical environment suited to the child. 

Professional and non-professional personnel consider the physical environment in 
which thev work as a factor in their satisfaction with their position. This is not purely 
for their own comfort, but is of consequence because thev desire to do the best work 
of which thev are capable in a physical environment planned and operated for the 
use of children only. Physical en\'ironment undoubtedly is a factor in securing and 
retaining a thoroughly competent staff for the children's unit. Throughout the hospital, 
diagnostic and treatment areas must be designed to meet the particular needs of the 
child, for example there should be a recovery room set aside for pediatric patients; a 
recovery room with physical construction suitable for the child and manned by per- 
sonnel who understand the particular needs of the pediatric patient. Roentgen facilities 
should be so designed that the child can go directly to this area without being trans- 
ported on elexators crowded with adults. Upon arri\'al, he should see only those 
professional people who understand him as a child and not be exposed to the sight of 
seriously ill adults from other parts of the hospital. A unit set aside to perform pediatric 
micro-bio-chemical determinations should also be created within the general laboratory 
of the hospital. 

A floor of the pediatric building should be set aside for pediatric laboratories devoted 
to pediatric research. Construction should be such that they have movable partitions 
to permit increasing or decreasing laboratory size as projects require. 

It is recommended that these facilities, for the care of the child, be combined in 
a new unit to be attached to the newly proposed out-patient building of the University 
Hospital. They should be constructed in such a manner so that on the first floor of the 
pediatric building, the out-patient and emergency rooms will bear a horizontal geo- 
graphic relationship to the adult emergency and out-patient areas, but with essential 
separateness maintained. It would seem that such a unit can be constructed in a manner 
to provide the basic pediatric needs expressed in the foregoing and \ ct at the same time 
to make use of facilities in the other parts of the general hospital. 



POSTGRADUATE COMMITTEE 

I. General Statement of Operating Plan and Ideology 

Medical education, subsequent to graduation from an acceptable medical school 
involving the granting of a diploma as a Doctor of Medicine, falls into three natural 
subdivisions. 

A. The first of these is designed to give a groundwork in clinical medicine as 
represented by an internship and further, to prepare men for specialties, as 
represented by residencies and fellowships. This type training, of course, is full 
time and usually involves living in a hospital or other medical institution. 

B. Graduate education, designed for very complete training in a certain branch of 
medicine and involving an additional degree, is a rarity in this country. 

C. The third type, which is designed to keep a medical graduate abreast of ad- 
vances in clinical medicine, is usually of an entirely different nature, and it is 
with this latter type that we are concerned. 

Because of the nature of the objective, education of this type is usually given in 
short courses, without formal credit resulting from their completion. It has been 
designated Postgraduate Education. 

In considering our problem, it must be remembered that we do not have captive 
audiences available, such as undergraduate students, men attending for credit toward 
certification, men attending upon orders of some governmental agency, or an industrial 
plant for which they work. 

Also, it must be remembered that we are not sending well-advertised "Star Speakers" 
to some medically backward community preceded by a great fanfare of publicity and 
provided with a more than liberal expense account. 

On the contrarv, our audiences must be obtained from a highlv sophisticated group, 
in competition with other schools and with medical groups holding meetings of their 
organizations, and frecjuently heavily subsidized by commercially interested firms such 
as drug houses and others. A prime example of this is shown in the list of subsidizers 
of a recent nose and throat meeting in Baltimore. 

Problems involved are well presented by Vollan in the A.M. A. publication, Post- 
graduate Medical Education in the United States. Unfortunatelv, manv excellent 
teachers in medical schools have a completely naive conception of the entire problem 
because of their lack of experience in administration in this field. Some men cannot 
bring themselves out of their ivory towers in spite of Osier's statement, "There are 
manv problems and difficulties in the education of a medical student, but they are not 
more difficult than the question of the continuous education of the general practitioner. 
0\'cr the one we ha\'c some control, over the other, none. The uni\'ersitv and the state 
board make it certain that the one has a minimum, at least, of professional knowledge, 
but who can be certain of the state of that knowledge of the other in fi\e or ten vears 
from the date of his graduation? The sjiecialist ma\' be trusted to take care of himself— 
the conditions of his existence demand that he shall be abreast of the times; but the 
familv doctor, the private in our great armw the essential lactor in the battle, should 

123 



124 BULLETIS Of THE SCHOOL OF MEDICINE, U. OF MD. 

be carefully nurtured bv the schools and carefully guarded b\ the public. Humanly 
speaking, with him are the issues of life and death, since upon him falls the grievous 
responsibility in those terrible emergencies \yhich bring darkness and despair to so 
many households. No class of men needs to call to mind more often the wise comment 
of Plato that education is a lifelong business." 

II. Faculty mid Staff 

Because the courses are short and because no formal credit is granted, it has been 
the custom in most medical schools to have no permanent faculty in the ordinary sense. 
Some institutions do have a very limited, full-time staff but, in the main, the great bulk 
of the teaching is done by members of the different con\entional departments in the 
medical school and this has been the plan used here. At this point, it seems only fair 
to sav that the Committee has. in the main, received excellent cooperation from the 
members of the faculty and this support given the Committee's efforts has been gratify- 
ing. Since its inception the Postgraduate Committee has felt that a laborer is worth his 
hire and a consistent effort has been made to recompense, insofar as such has been 
possible, all those teachers whose services ha\e been enlisted. We sincerely trust that 
nothing will occur that will make this impossible or will impair the effectiveness of our 
policy in the future. 

III. Teaching 

Because of the definite limitations of our objectives, as expressed in Section I above, 
our major effort has been directed toward pro\iding re\'iew courses for graduate 
physicians. There have been some deviations from this in that the Committee has 
organized certain courses that have been of value to men in specialties and men who 
have desired later certification. As examples, mav I mention the course in Surgical 
Anatomy and the off-campus clinical teaching in Gynecology and Obstetrics which 
has been done in Salisbury in recent years. Dr. Haskins, Professor of Gynecology and 
Obstetrics, has told the Committee that in his opinion these have been well received 
and have been \'er\' valuable to the men availing themsehes of this opportunit)' for 
instruction. The course in the Basic Sciences As They Apply to the Practice of 
Medicine has been enthusiastically received and, we belie\'e, has been of great value. 

IV. Research 

The Committee has indulged in no formal research as ordinarily conceived. 
However, we believe that our attempts to present new courses such as those mentioned 
immediately above, actually do represent research because we think that trials of new 
ideas such as these with the careful appraisal of their success, might be considered in 
this category. We do not believe that we should indulge in hastily conceived courses 
that might result more from momentary enthusiasm than from actual need. 

V. Graduate Program 

The Committee has no program of this type at this time and unless the original 
definition of Postgraduate Education is changed insofar as it applies to the acti\ities 
of the Committee, there will be none in the future. 



POSTGRADUATE COMMITTEE 125 

VI. Statisiical Analysts and Work Done and Service Wendered 

A. Ten-week course at Wilmington, Delaware, for the Delaware Academy of 
General Practice. Attendance: 50 physicians. 

B. Weekly television show over WBAL-TV. 

C. Twenty-one week course in Basic Sciences. Enrollment: 56 physicians. 

D. Surgical Anatomv course, fifteen weeks duration: 14 surgeons enrolled. 

E. One dav seminar for the Maryland Academy of Clcneral Practice on Decemhcr 
13. Attended by 75 physicians. 

F. Three-day short course in Industrial Medicine. The response here was only fair. 
However, I believe that a lot was learned and from conversations with the men 
present, I believe that, with adjustments, this course can become increasingly 
\'aluable. I believe, however, that it will have to be shorter than three days. 
More intensive contacts with interested men will have to be had and perhaps 
better planning of the course would be in order. 

G. Scientific session for alumni and Maryland Academv of General Practice, on 
June 6. This will be lectures and television will be used. 

H. Monthly OB-GYN lectures at the Peninsula General Hospital in Salisburv. 
At the request of Dr. Haskins, Professor of Obstetrics and Gynecology, this will 
be extended under his supervision to Easton, Maryland, for a trial period of 
several months. If Dr. Elaskins believes that it is valuable then it will be 
continued for the remainder of the year. 

I. Pro\'ident 1 lospital 

1. Actually I have not been satisfied with our arrangement at Provident and 
at my request Dr. E. R. Shipley, who has represented us at the hospital in 
question, has submitted to me a report. I plan to bring Dr. Shipley's remarks 
before a future meeting of the Committee for such action as thc\' mav deem 
proper. 

VII. Facilities and Ecjjtipvieni 

The Postgraduate Gommittce has excellent oflice facilities. In addition, actualK' 
upon an experimental basis, the Committee secured television equipment for use in 
teaching on the campus. This activity, we all know, has received far greater emphasis 
in many other institutions where far greater resources have been available. The Com- 
mittee is of the opinion, however, that this is developing satisfactoriK and we trust 
that it can jilav a greater part as time goes on if our ec|uipnient is expanded and if 
proper jicrsonnel for its operation is authorized. 

The C'onimittee also has certain iihotograjihic c(|iiipnirnt w hicli we hope will play 
an increasingK' imjiortant part in education as times goes on. This ec|uipment is, of 
course, purely a supjilement to the much more elaborate equipment in the Art Depart- 
ment. We have endeaxored in exery way to make our facilities available, not only to 
the medical school for postgraduate education, but to the other professional schools on 
the Baltimore campus whenever possible and insofar as such was possible. 



126 BL/LLETZ,\ OF THE SCHOOL OF MED1C1\'E. U. OF MD. 

V'lII. CouiniiDiitr Seri'ice 

The Postgraduate Committee has heen responsible for the pubhc television show, 
TV-MD. whieh has been broadeast over Station WBAL-TV in Baltimore for the past 
six years. It is of interest to note that it has a rating that is eonsidered excellent in the 
tele\ision industrv for a public service program. It is of further interest to note that 
this is the oldest continuous medical program on the air in the United States. The 
officials at WBAL ha\ e expressed the opinion that the program has been \'ery satis- 
factors% has served a public need, has received excellent public acceptance and they 
are definitelv desirous of continuing this acti\ it\ . The Committee plans to keep TV-MD 
on the air. 

IX. Puhlicatious 

Because there has been heretofore no current publication that might be available 
to ad\"ertise current activities in the medical school, Dean Stone suggested last vear 
that such a publication be instituted. As a result of this a publication issued weeklv and 
called "CALENDAR OF EVEXTS" was started. This periodical is sent not onlv to 
men actuallv on the campus but to hospitals throughout the state. It is gratifying to 
note that it is posted on manv hospital bulletin boards. 

Apparentlv it has met a need because the circulation has graduallv grown and 
now totals 210. I might sav that all increases in circulation are as a result of requests 
for inclusion in the mailing list. Actuallv, the Committee has invited recipients to 
remo\'e their names from the mailing list if thev did not believe that the "CALENDAR" 
was of value to them. This has represented a verv sizable project and I would like at 
this point to commend the office staff of the Committee for their excellent work in 
producing this periodical. 

X. Recommendations for hnprovevient 

A. Medical Faculty for the Postgraduate Committee 

It does not seem advisable to attempt the creation of a special Postgraduate 
Committee faculty. We have attempted to be helpful in some degree to the 
department participating by paying lecturers and also jnaking sums available 
to the department from time to time to assist them in their work. This plan 
seems to have worked satisfactorilv and I do not believe a change is in order. 

B. Audiovisual Subcommittee 

Audiovisual teaching has become of such great importance that a subcom- 
mittee of the Postgraduate Committee was designated some vears ago to foster 
this activity in the Medical School. The Audiovisual Subcommittee, headed by 
Dr. E. Roderick Shipley, has been responsible for the public television show, 
TV-MD, which— in my opinion— has been quite successful. I believe that our 
plan of a rather "homey" show— without too much professional o\'ertone, is much 
to be desired over the highly dramatic and, frankly I think, artificial shows put 
on by other institutions. I do not belie\e we desire or can compete in the field 
of medical theatricals. 



POSTGRADUATE COMMITTEE 127 

C. Public Relations and Public Instruction 

One of the most pressing needs of the medical school, in my opinion, is the 
engaging of an adequately trained and experienced director of public informa- 
tion and public education. I do not believe that this function should be combined 
with the function assigned to the Audiovisual Subcommittee. In my opinion 
the latter is for the ]:)urp()se of improving teaching methods in the medical 
school insofar as audioxisual tcchnit|ues can be helpful. I do not believe that it 
should be confused with public ctkication and information. 

I believe that ii the proper man were secured to direct public education and 
information he should ha\'e as a further function the exploring of sources of 
additional lunds, particularly for extra curricular activities of the conventional 
type. Drug houses and many lav organizations have exidenced great interest and 
certainly ha\e been most helpful in promoting meetings of state and special 
societies. Also I believe possible help might be obtained from the Federal 
Government if the matter were studied intensively and if areas of interest to 
that group in this type activity could be developed. Certainly, the national 
societies such as the Cancer Society, the Heart Society and so forth might 
welcome such help in teaching, etc., as we could give; and in turn the\ mioht 
be willing to view our needs sympathetically. 

Respectfully submitted, 

Howard M. Hubert, M.D. 
Chairman and Director 



DEPARTMENT OF PREVENTIVE MEDICINE AND REHABILITATION 

The Annual Report will cover changes and de\ elopments in the three Dixisions of 
the Department, that is, (A) Public Health and Hygiene; (B) Community Medical 
Care, and (C) Rehabilitation. 

A. Ptthlic Health and Hygiene: 

1. Personnel: Faculty members assigned to this division include Dr. Huntington 
Williams, Professor of Public Health and Hygiene; Dr. Ross Davies, Associate 
Professor; Dr. Matthew L. Tavback, /\ssistant Professor; and Lecturers in Public 
Health. This group was strengthened by the appointment of Dr. Robert E. Farber 
as Assistant Professor of Preventive Medicine, part-time. Dr. Farber was Deputy 
Health Officer in charge of the Western Health District. In addition to his gi\ing 
part of the lecture course to the second year students, he also organized and super- 
\'ised three field trips taken by each student and ser\ed as a consultant in public 
health matters to students making home \isits durina their third and fourth vear 
to clients of the Medical Care Clinic. 

Mr. George Watson resigned from his departmental position as Associate in 
Public Health in order to accept a position with the State Department of Health in 
Michigan. 

2. Undergraduate Instruction: Instruction of undergraduate students, consisting 
of a course in biostatistics by Dr. Matthew L. Tayback in the first )ear, and the 
courses of lectures in epidemiology and disease control and community' medicine 
in the second and third year, were carried on as in the previous vear with the 
exception of a few changes in lecturers. 

Conferences were held between the Head of the Department, Dr. Huntington 
Williams and Dr. Matthew L. Tayback which led, in the latter part of the year, to a 
formal application to the LInited States Public Health Service for a training grant 
in biometry and epidemiology. It was proposed in this application that there be 
instituted a program whereby the Department of Preventive Medicine would make 
available to all Departments in the School, on a fixed schedule of appointments, 
the services of a trained, clinical biostatistician to assist in the design of projected 
research and in the analvsis of research data. The proposal also envisaged holding 
a series of seminars for the House Staff and Faculty on the commoner biostatistical 
problems encountered in medical research. In addition, the facult\' members in this 
Section of Biostatistics and Epidemiology would be selected from those capable and 
interested in conducting epidemiologic research, utilizing the facilities of the school 
for the provision of clinical material. 

In view of the uncertainty of obtaining public health service grant funds, appli- 
cation was made to the Kellogg Foundation for authorization to use surplus Kellogg 
Foundation grant funds to establish this Section on Biostatistics and Epidemiology. 
Such authorization was obtained before the end of the scholastic vear. 

B. Community Medical Care: 

1. Personnel: Faculty members prexiouslv assigned to this division included Dr. 
Alexander S. Dowling, /\ssistant Professor of Pre\enti\e Medicine; and Mrs. Mary 

129 



130 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF AID. 

BrumHcld, Assistant in Preventive Medicine. Dr. Joe L. Stockard, Associate in 
Preventive Medicine, v\'as made Assistant Chief of the Medical Care CHnic re- 
placing Dr. Rav J. Beaslcv who resigned his position in order to enter into private 
practice. The services of Mrs. Marv Brumficld were augmented by the appointment 
of Miss Margaret Hawkins as an Assistant in Preventive Medicine (Social Service). 
The position relinquished bv Dr. Joe L. Stockard, in charge of the organization of 
the Home Reports and Disposition Conferences, v\'as taken by Dr. Aubrey D. 
Richardson. 

2. Undergraduate Instruction: The program of third vear students was altered to 
take advantage of the slight increase of time available so that each student spends 
eight Tuesdav afternoons in Preventive Medicine. Four of these afternoons were 
spent in examining patients and evaluating their phvsical disability in the Medical 
Care Clinic. At the termination of these afternoons, each student selected a patient 
whom he was to follow in his home until he reported on him in the fourth year. 

In the fourth year each student attended a home report conference on four 
successi\'e afternoons. The attendance to these classes as well as the Disposition 
Conferences remain unchanged. 

The fourth vear students continue to visit the Chronic Hospital at Montebello, 
at first for two afternoons a week and during the latter part of the year one afternoon 
a week. 

C. Rehabilitation: 

1. Personnel: The personnel included previously are Dr. Florence I. Mahonev, 
Associate Professor of Rehabilitation and Miss Dorothea Barthel, Instructor in 
Rehabilitation. On October 1, 1956, Dr. Samuel M. Reichel was appointed as 
Assistant Professor of Physical Medicine and Rehabilitation on a geographic full- 
time basis. 

Dr. Reichel was placed in direct charge of the In-patient and Out-patient Phys- 
ical Therapy Clinics and what existed of the Out-patient Occupational Therapy 
Clinic. The year saw the appointment of Miss Ruth Latimer as Chief Phvsical 
Therapist together with several assistants. The growth in the attendance of the two 
Physical Therapy Clinics was satisfactory. Little progress was made, however, in 
developing the Occupational Therapy Clinic since a Chief Occupational Therapist 
was not obtained. 

2. Course for Physical Therapists: In addition Dr. Reichel served as Director of 
the Division of Phvsical Therapv with Dr. Gladvs E. Wadsworth as Executive 
Officer. LInder Dr. Wadsworth, in conjunction with the Department of Physical 
Education at College Park, a four xear course was established in Physical Therapy 
leading to a Bachelor's degree. Previouslv the Junior and Senior vears had had to be 
given at other hospitals. During this vear the first junior class was given instruction 
at the School of Medicine in the Division of Physical Medicine. 

Maurice C. PincofFs, M.D. 

Head of the Department of Preventive Medicine and 
Rehabilitation 



DEPARTMENT OF PSYCHIATRY 

INTRODUCTION 

In describing the major activities of the Psychiatric Institute during 1956-1957, I 
have found it necessary to include some material on the structure of the institute, its 
purpose, its program and the steps we have taken in carrying out this program. The 
present report is essentially a summarv of the more complete reports presented to the 
Director of the Institute by various section heads and other staff members. 

During the past year, teaching and research functions have expanded. The in- 
patient facilities of the institute have been used to the maximum; the percentage of bed 
occupancy has been close to 90 per cent. The therapeutic program has become stabilized. 
Dr. Raymond Band and Dr. Charles Bagley have been helpful in setting up a more 
organized and integrated service. The residency training program has been strengthened 
by conferences and seminars given weekly by Dr. Otto Will, Dr. Jerome Hartz and by 
Dr. A. Russell Anderson. Dr. Charles Ward, Dr. William Harris, and Dr. William 
Fitzpatrick have joined our supervisorv staff. The nursing service has been more closely 
integrated with the therapeutic work of the resident staff, largely through the efforts of 
our new Associate Director of Nursing, Miss Marguerite Termini and her supervisory 
staff. Under the guidance of Dr. Klaus Berblinger our clinic services have expanded. 
Many more patients have been treated and the type of treatment has been more 
intensive. The emergency service has become a major teaching asset as well as a very 
busy service unit. Our comprehensive medical clinic which meets in the medical out- 
patient department has, under the direction of Dr. Sidnev Easterling, cared for a 
large number of patients. Dr. Charles Bagley set up an adolescent clinic to meet the 
needs of local practitioners and of the courts. The Child Guidance Clinic in the 
Psychiatric Institute and the Mental Hygiene Society Child Guidance Clinic have 
reported varied and interesting programs; and I believe, we are beginning to have 
success in reaching the pediatricians in the community. Our joint efforts with Dr. 
Edmund Bradley and his staff, have been interesting and productive to both depart- 
ments. 

The Department of Psychology under the direction of Dr. Lester Libo, has had an 
active clinical, training and research program. It has received accreditation as one of 
the few Departments of Psychologv recognized for graduate training in clinical 
psychology. Our Social Service Department, under the direction of Mrs. Imogene 
Young, has gradually organized its service and teaching program. Mrs. Young and her 
staff have been actively involved in teaching medical students and nurses. Mrs. Young 
has organized and been the leader of a two-day workshop on the Family and Mental 
Health. This workshop, organized in collaboration with local social service organiza- 
tions, was attended by approximately one hundred social workers. The leaders of this 
workshop were well-known, national figures in the fields of sociology, social work and 
psychiatry. The Department of Occupational Therapy, under the direction of Mr. 
Roman Nagorka, has expanded its work with both in- and out-patients. The addition 

131 



132 BULLETIN OF THE SCHOOL OL MEDICINE, U. OL MD. 

of rocrcational thcrap\' and music therapy, we feel, has heeii most heneficial to patients. 
With the help of Mr. Boris Ahngo, sexeral new teehnic|iies were introdueed in 
Occupational I herap\ . 

Our research program, likewise, continues to cxpantl. W'e wckonie l)i'. Jerome 
NK'ilis. Ohiel ol the Llectroencephalographic Department. Dr. Orenell and his i^ioup 
are furthering their work in neurophysiologv and hiochemistrx as applietl to the 
problems of jisxchiatrx. I lis work on hrain metabolism anti on the biochemical actions 
of the tranquili/ing drugs, is reaching a wider audience. Dr. Oallawax is continuing 
his work on perception and the autonomic ncr\ous s\slem and on the ascending 
reticular system. Our j^roject on the assessment of teaching in j)svehiatrv, is well uiulcr 
way with the help of Dr. llaryey Robinson and Dr. Benjamin Pope. The project on 
the emotional factors of children with poliomxelitis is reaching its lifth anti terminal 
\ear. Dr. Haryey A. Robinson, the director ol this project and his stall arc writing u[) 
the material for publication. Dr. John Reid continues his vyork in teaching and in the 
application of ]:)hilos()phy to the greater elarilication and broader understanding of the 
problems in j^sychiatry. 

Wc are enthusiastic about our imdergraduatc teaching program in psNchiatry. 
Interesting de\'elopmenls ha\'e occurretl in the Inst year course, some ol which are 
being written up for publication. Wc arc gradually Ilnding ways of enabling medical 
students to haxe more direct research and clinical experience with patients in the 
Psychiatric Institute. This year wc haye been able to appoint eight medical students 
to summer fellowships h)r research and clinical work in \arious departmental acti\itics. 
These fellowships ha\'e been su|:)ported by the United States Public 1 Icallh Scr\ ice 
and by a grant from the Smith, Kline and French Company. 

During the past year, with the help of Mr. lioris Margo, we have had two e.xhibi 
tions of the paintings and drawings of eight Baltimore artists. These exhibitions were 
in the Ps\chiatric Institute and were set up to illustrate the steps in the creatixe process 
of these artists. 1 he exhibits haxe created considerable interest locally and elsewhere 
and we plan to continue them. Dr. lunesinger has just accepted the cditorshii") of the 
jdiinidl ()( Nervous and Mental Disease. We hope this will tinn out to be an interesting 
antI productive de|xutmental x'cntine. 

Om- stall has been considerably strengthened b\ the appointment of Dr. liugene 
Brody of Yale Uniyersity, as Professor of Psychiatry. I Ic will take oyer the res]X)nsi- 
bilitics of our residency training program. We welcome the appointments of Dr. Otto 
Will as Associate Clinical Professor of Psychiatry, Dr. Jerome I lart/ as Associate 
Professor of Psychiatry, Dr. /\. Russell Anderson as Associate Clinical Professor of 
Psychiatry, Dr. Francis McFaughlin as Instructor in Psychiatry, Dr. William Harris 
as Associate in Psychiatry, and the members of our resident stalf, listed below. We 
regret the resignation of Dr. Lester Libo, Chid of our Psxchology Dixision. 



DEPARTMENT OF PSYCHIATRY 



133 



Chief Residents: 
Dr. George Longley 



RESIDENT STAFF 



Dr. Robert Trattner 



Assistant Residents: 

Dr. Octavio Aguilar 
Dr. Celestino Casillas 
Dr. Earl Cohen 
Dr. WiHiam Holden 
Dr. Frederick Lam 
Dr. Adoracion Tanega 

Trainees: 

Dr. Norman Bacher 
Dr. Jean Coylc 
Dr. Dennis Jones 
Dr. lack Raher 



Dr. Anthony Hordern 

Dr. Murray Kappehnan 

Dr. Edward Keelan 

Dr. Pearl Ketcher 

Dr. Sonia Raines 

Dr. Hector Ramirez-Honev 



Dr. Charles Belts 
Dr. John Hamilton 
Dr. Elaine Jones 
Dr. Albert Winer 



Section I 
OBJECTIVES OF THE PSYCHIATRIC INSTITUTE 

The activity of the Psychiatric Institute is centered in the three areas of cUnical 
service, teaching, and research. The Department of Psychiatry stresses the need to 
promote a keen and growing intellectual atmos^ihere in its teaching program, as well 
as in the areas of study and research that aim to widen and deepen our understanding 
of human behavior. It has consistently maintained that for high standards in these 
two areas a competent lull time faculty is a prime necessity. 

As its major educational activity the department is engaged in training medical 
students, residents in ps\'chiatry, nursing students, students in ps\'chologv, social service 
and other ancillar\ (ields to e\'aluate and treat mental illness. The essential method 
depends on close supervision of students, which cannot be accomplished without an 
adetjuate full-time staff. At the same time the department belie\es that it must proxidc 
the student with a broad spectrum of |)atients and treatments. This recpiires a faculty 
of a multi-disci|ilinar\' character. 

C'linical service is a major activity of the Institute. In treating hundreds ot ]xuients 
a year, the Instittite is recognizing its responsibility to the State of Maryland. But at 
the same time, it entertains a goal of longer range: the training of |irofessional per- 
sonnel who can idtimately meet the need of greater and greater numbers of sick people 
in the State. This training includes skill with preventive measures as well. The 
activities of the clinical service consist of the in-patient and the out-patient treatment 
of psychosis, neurosis, and psychosomatic disorders in adults and in children. 

Research is considered of great importance by the Department in order to present 
a stimulating atmosphere for the education of the student. Major emphasis upon 
methodolocjv is considered necessar\' in trainino in medical science and clinical care if 



134 BULLETIN OF THE SCHOOL OF MEDICINE, 11. OF MD. 

the highest standards arc to be maintained. This research orientation is suffused 
throughout all acti\'ities of the department. 

A ps\chiatric department is the most realistic link between the hospital and medical 
school and the conimunit\. Social and interpersonal problems experienced in the com- 
munit\ are intimately related to medical and surgical diseases which hnd their vva\' 
into the hospital. The department is developing its relationship with the community 
and the state to ad\'ance its pre\enti\'e program and to assist in developing better con- 
tinuitx' of care for patients. Since professional students graduating from the Uni\'crsity 
will function in the communitv and the state, it recognizes also that they should be 
prepared for these functions while thev are \'et students. 

The objecti\'es of the training program are: (1) to train the resident to be a 
competent clinical ps\chiatrist; (2) to gi\'e him ti'aining in scientific methodology and 
research; (3) to give him knowledge in the basic sciences as thev relate to psxchiatrx'; 
(4) to gi\'e him training in the field of human relationship; (5) to gi\'e him experience 
in teaching, and (6) to give him methods and experience in the inter-relationships of 
psvchiatrv to the other medical disciplines. To achie\'e these objectives the department 
takes the responsibilitv for the following areas of instruction: (1) Clinical sei"\'ice in 
which the resident works with a variety of in-patients and out-patients in the ps\'chiatric 
wards and clinics, on consultation service to other departments of the hospital, and in 
liaison with communitv, public health, and social agencies; (2) through a curriculum 
consisting of seminars dealing with topics in the physical, social and behavioral sciences 
as thev relate to psvchiatrv and medicine; (3) through active participation in research 
projects; (4) by close supervision carried out through regularh' scheduled indi\'idual 
and group supervisory hours. This total curriculum and training experience prepares 
residents for certification bv the American Board of Psychiatry and Neurology. 

During 1956-1957, major changes occurred in our undergraduate teaching program. 
Several additional instructors were assigned in our first year course so that groups of 
three students could be superxised while working with the patients assigned to them. 
During the second semester, the students were asked to select a topic for study. These 
topics dealt with problems brought up in working with their patients. The topics were 
set up to encourage speculation and experience in dealing with theory; thev were read 
before the class and later distributed to the entire class. 

During the second year, the emphasis is on the understanding of psychodvnamics 
and psychopathologv as applied to mental illness. 

The third year clerkship was lengthened to a three week period for three students 
at Springfield State Hospital and for four students at the Spring Crove State Hospital. 
Each student was assigned to a preceptor at the hospital who supervised the student's 
clinical work and his records. Students presented patients at the staff meetings and 
assumed much more responsibility than heretofore. 

In the fourth year clerkship, the period of night work was extended for each student 
to two weeks. The student schedule was arranged so that they could attend the staflF 
conference on Friday mornings and the seminar meetings of Drs. |erome Hartz and 
Otto Will. The afternoon seminars were increased in number to include meetings led 
by Mrs. Imogene Young, Dr. Robert CTrcncll, Dr. Lcopoltl Max, and Dr. /Xndiony 
Hordern. 



DEPARTMENT OF PSYCHIATRY 135 

Eight students were selected From the classes for summer clinical fellowships, which 
enabled them to work throughout the three summer months at a stipend of $200 
a month. 

The Fellows were Aristides Alevizatos, John Cadden, Michael Fellner, Ramon Roig, 
Bernice Sigman, and Lois Young of the second year class, Daniel Sax of the third year 
class, and Adrien Wevn of the fourth vear class. 

THE PSYCHIATRIC RESIDENCY TRAINING PROGRAM 

The Psychiatric Institute is accredited for a three vear Residency Training Program. 
The Institute provides for the training in any one year of thirteen assistant residents 
and two chief residents. During the current year the department has seven assistant 
residents and two chief residents. The positions of chief resident are available to 
psychiatrists in their fourth or fifth year of training. During the current year, the 
department had six trainees, subsidized by U. S. Public Health stipends. 

More intensive supervision has been available to our residents, and the addition of 
seminars by Drs. Will, Hartz, and Anderson have rounded out the program. More 
extensive work has been made possible in neurology with Dr. Charles VanBuskirk 
and with Dr. Jerome Merlis. One of our residents spent three months under the 
direction of Dr. VanBuskirk. Several residents have become involved in our teaching 
program. The senior staff has interested se\eral of our residents in research problems. 
We hope that these programs will all be extended. 

The Institute Program Committee under the chairmanship of Dr. Benjamin Pope, 
has arranged a series of staff conferences at which papers have been presented by 
prominent psychiairists, psychologists, and authorities in the ancillary fields. The list 
of meetings is appended. 

Section II 

IN-PATIENT PROGRAM 

The Institute was planned for the upper three floors, divided into six wards with 
about 104 beds, to be used for in-patients. For psychotic patients, the plan included 
the use of four wards in which the nursing care and ward management could vary in 
steps, accommodating to the progressive stages of the patient's illness. One ward was 
set up for the treatment of psychosomatic and psychoneurotic patients, to fit into the 
needs of the general hospital, and to be the center of our work with internists, surgeons 
and medical specialists. The sixth ward was planned for the in-patient care of disturbed 
children. There is no in-patient service of this kind at present in the State of Marvland. 
Owing to shortage of space. Ward 4G is at present occupied by the Division of 
Neurosurgery of the Department of Surgery. Ward 4F is at present used for residents' 
quarters. We hope that these space problems will be dealt with so that the Psychiatric 
Institute will be able to carry out its program. 

During 1956-1957, the In-Patient Service occupied wards 2F, 2G, 3F, and 3G, 
with a complement of 62 beds. During this year, the In-Patient Dejxirtment has been 
filled to capacity. About 20 per cent of these patients were under the care of private 
phxsicians who usually referred suicidal patients and patients with depressions and 



136 Bl/LLETJi\ OF THE SCHOOL OF MEDICINE, II. OF AID. 

panic states. Every patient was assigned to a resident and in most instances, the resident 
was able to assume complete responsibility tor the patient. 

Ward 3G was set ii]-) lor the intensive study of psychosomatic and psxchoneurotic 
patients. This t\ pe of ward ties psychiatry directh to the general hosjMtal and to the 
medical, surgical, and speciaitx clinics. \A'e are able, in this ward, to directly observe 
the effect of emotions, situations, and the beha\'ior of the doctor and the ward personnel 
on the symptoms in the course of medical and surgical illness. From these obser\'ations, 
methods of control and treatment can be tried and taught. The role of the doctor as a 
team member, with the nurse, aide and social worker in treating the medical and 
surgical patient can be worked out and taught. During the present vear 10 Assistant 
Residents from the Department of Medicine spent one month on 3G. In addition to 
Assistant Residents in Medicine, members of other clinical departments— Drs. Van 
Buskirk, Woodward, Robinson, Buxton, Haskins, Hull, and other staff members— have 
seen patients in consultation on 3G. Drs. Lisansky, Hartz, and Reed have taken an 
acti^'e role in working with patients and in teaching. Dr. Charles Betts has been \'erv 
helpful in trving to relate the work of 3G with problems in medicine and in surgery. 

During the past vear 507 patients were admitted to the in-patient service. The 
average bed occupancy was 86 per cent, which was above the 82 per cent level of 
occupancy set by the hospital. The total number of patient bed days was 19,461. The 
bed occupancy has ^'aried little from month to month. The percentage of free ser\'ice 
has been kept well within hospital policy bv carefully planning and administering our 
admission policy. There are no comparative figures from the University Hospital 
available to indicate the exact percentage of free service. Dr. Charles Baglev has done 
an excellent job in setting up and carrying out these policies. 

Most of the patients admitted come in as institute patients and are able to pay the 
regular institute charge for room and board. Since January the all-inclusive fee was 
eliminated and patients in the institute pay the regular charge for ancillary services. 
This has increased our income, but no figures are available to indicate to what extent. 
About 15 per cent of our patients are admitted as the prixate patients of our staff 
ph^sicians. We have been fortunate in avoiding many of the pitfalls of the "open" 
system by gi\'ing hospital privileges to our part-time teachers and super\isors. All 
patients are assigned to our resident staff or students and in this yyay all patients are 
available for teaching and supervision. 

Between 60 and 70 per cent of our in-patients have psychoses, with a preponderance 
of schizophrenic patients. During the past vear we have admitted sexeral adolescent 
patients and children. These admissions were in response to community need and ha\'e 
pointed out the necessity for a children's in-patient ser\'ice. All patients are treated bv 
psychotherapy and approximately 20 per cent recei\'e intensive psychotherapy over 
long periods of time. We advocate the planned use of tranquilizing drugs and the use 
of insulin and electric shock when needed. Studies are being carried out in the in- 
patient service on reactions to drugs, autonomic ner\'ous system functioning, group 
therapy, and on the social structure of the ward. 

In addition to the specific therapies we recognize the influence of the ward, its 
organization and the interrelations of the professional staff on the symptoms and 
behavior of the patients. In light of modern trends in psychiatric therapy we are 



DEPARTMENT OF PSYCHIATRY 137 

exploring the usefulness of "milieu" therapy. The question here is how we can best 
use the hospital environment for treatment purposes. We rely heavily here on the 
nursing service, on the contribution of the ancillary services of occupational therapy, 
recreational therapy— and are exploring with our social service department the use of 
the family as a therapeutic agent. 

During the past year more patients have been admitted from the general hospital— 
mostly as free patients. We have had several admissions from the Student I lealth 
Department at College Park and from the State Hospitals. We plan to explore our 
liaison with the State Hospitals and to also set up joint projects and research xcnturcs. 
Dr. Callaway has already initiated such projects at the Spring Grove State Hospital. 

Our original plan called for the use of Ward 4G for the care, treatment, and investi- 
gation of the problems of disturbed children. This ward was visualized as being the 
in-patient section of our child guidance clinics. This would be a unique ser\'ice and no 
similar facility exists in Maryland. After opening the new child guidance clinic in the 
department of pediatrics, we felt that our next stop was the opening of this ward. We 
were unable to do this and at present, 4G is occupied by the Department of Surgery. 

The children's in-patient service was set up with 14-18 beds to allow for both long 
and short term care. The ward was designed with ample recreational and school space 
and each room was set up to be a combination living room and bed room. The ward 
can be set off in sections to deal with different groups of children with a variety of 
children's problems. Our plan was to have two ongoing groups of children for intensive 
study in the in-patient unit. During the past vear we have had to admit 6-8 children 
to our adult wards because of communit^' need. This ward together with our child 
guidance clinics would make it possible for psvchiatrists, pediatricians, students, social 
workers, psvchologists, and other personnel to work in child psychiatry. 

Section III 

OUT-PATIENT CLINICS OF THE PSYCHIATRIC INSTITUTE 

The Adult Out-Patient Clinic of the Psychiatric Institute is the successor to the 
old Mental Hygiene Clinic which was situated in the clinic building on Greene and 
Lombard Streets and at that time, represented the Department of Psychiatry of the 
School of Medicine, LIniversity of Maryland. With the opening of the Psychiatric 
Institute in November, 1952, the Psychiatric Out-Patient Clinic moved into the new 
building at 645 West Redwood Street where the Adult Out-Patient Department 
occupies the main floor and part of the first floor and the Child Guidance Clinic 
occupies part of the Terrace Floor. 

1. Adult Out-Patient Psychiatric Clinic. 

During the past year 1175 new patients were seen in comparison with 897 seen in 
1954 and 1 1 16 in 1955. The number of treatment hours in 1956 was 5614, an increase 
over 4580 treatment hours in 1955, and 4454 treatment hours in 1954. 

The average number of patients in active treatment is 178 per month. In addition 
to these patients, 216 new patients and 761 return visits were registered h\ the Com- 
prehensive Clinic, which since January 1, 1956, has come under administrative super- 
vision of the Adult Out Patient Clinic. 



138 ;u///FT/\ or TiiF scnooi or mi-dicinf. ii. of md. 

niiring a typical month last vcar, thirt\ -six physicians were sccini; a \ arying nunihcr 
ol Out-patients, the heaviest load being carried h\ the senior resident on the outpatient 
ser\ice and five assistant residents who were assigned lor the major portion ol their 
Institute acti\ities to the tre.iimcni nl out |i.iticiits. Ihe other therapists included senior 
staff members, trainees, and sIlkUiHs, sii|xm\ iscil h\ the teaching stall. Among the 
trainees were eight psychiatrists Ironi other ps\chiatric iiospitals in the commimit\. 

2. Brief Contact Clhiic. 

The Out Patient Department also provides the services ol a HrieF Contact Clinic. 
Patients admitted to this clinic arc those who lor a \ariet\ ol reasons seem not suitable 
lor intensi\e insight ]is\cli()thcr.ip\ . hul dcrixc hcnclit ironi a continued ilcpcnilenc\ 
relationshij") and identilication with the clinic as such. 1 he Hricl Contact C'linic also 
sees |xiticnts who at one time or another were greatU disturbed, but who are able to 
lunction on a socialK acceptable lc\cl. 

3. W'cdncsdav Nioht Clinic. 

This clinic which meets exerv Wedncsda\ between se\en and ten, is stalled by 
psychiatrists Irom other psychiatric hos|iitals which do ni)t ha\c (uit patient lacilitics 
for the training of their stall members and thus, lurthers the training potential anil 
accreditation of these institutions. The .Adult Out Patient C linic provides three in- 
structors for indi\'idual supcrxision. Patients admitied to the i\'ight Clinic are those 
who are unable to come during the day. RecentK , the training facilities of the Night 
Clinic ha\c been extended to selected physicians who are not ps\chiairists, but in their 
indi\idual fields recognize the need for training in psychiatric principles and methods 
of approach. This clinic was instrimiental in helping the Spring Cro\e State 1 lospital 
and the Springfield State I lospital obtain their accreditation for a three \ear training 
program. 

4. Clinic for Pcrsoiialilr Disorders. 

This clinic was organized in 1955, under the direction of Dr. Manfred Cuttmacher. 
It was set up as a clinic lor dealing with the |>roblems of delint|uency and i^roblems 
referred to the Institute by the courts, the Big Brother League, and other social agencies. 
The chnic during 1956 used individual and group psychotherapy in several series of 
psychopathic patients. Weekly seminars have been held with probation olficers. The 
clinic has a close working relationshij) with the Patuxcnt Institute. 

5. Clinic for Alcoholic Puticuts. 

This clinic, under the direction of Dr. Isadore Tuerk, meets Saturday mornings. It 
is supported in part by the State De|xirtment of Public I lealth. Patients are treated 
individually and in grouj^s. One pinposc of the clinic is to pro\ itic intensixc therapy 
with a limited group of jwtients, who are at the same time studied psychologically and 
physiologically. Patients seen at this clinic can be admitted to the in patient department 
when necessary for more intensive treatment and stucK. I he clinic program is related 
to Dr. Robert Crenell's study of the elfects of alcohols on central nervous system 
functioning, supported by the National Research Council. Croup treatment is used 
for most ol the patients. This year several seminars are |)lanncd on the diagnosis, 
treatment and care of alcoholic patients for members of the jiolicc force. During the 
year approximately 50 patients were receiving individual and group treatment. 



DEPARTMENT OF PSYCHIATRY 139 

6. Adolescent Clinic. 

This clinic meets two and a half clays each week. Forty-one adolescent patients 
have been seen in a total of 324 hours. Six of these patients ha\e been treated by 
intensi\'e indixidual psychotherapN'. The others have been seen through the diagnostic 
|)hase. Some of them have been admitted to the PsNchiatric Institute for more intensive 
study and treatment. This clinic meets a communitx and a state need; there is no other 
facility in Marvland which proxides this service. 

7. Comprehensive Clinic. 

For the past three vears this clinic has been meeting ever\ Monday and Friday 
afternoon in the Medical Out-Patient Department under the superxision of Dr. Sidney 
Easterhng. Psychiatric referrals from the LIniveristy 1 lospital Out-Patient Departments 
are seen in this clinic. It has become an active teaching clinic, and is fully utilized in 
the teaching program for senior students. This clinic is an admirable liaison between 
psychiatry and the other medical specialties. During the past year 216 new patients were 
seen with a total of 761 return visits. 

CHILD GUIDANCE CLINIC 

The Child Guidance Clinic was organized in 1928 as a demonstration clinic and 
supported by the Commonwealth Fund and later, bv the Communit\ Chest. Under 
the direction of the late Dr. H. Whitman Newell, the clinic continued the traditional 
Child Guidance policv of offering intensive treatment for a limited number of carefully 
selected patients. The clinic was recognized as a training center by the /Xmerican 
Association for Child Guidance Clinics and acquired the reputation of being an ex- 
cellent place for training child psvchiatrists. The same polic\ continued when the 
Child Guidance Clinic moxed to its new quarters in the PsNchiatric Institute. 

Intensive individual treatment remains the preferred treatment for most of the 
children and their parents. The clinic has begun to expand and in 1956 included the 
resident staff among its therapists. The psychologic services are being expanded bv the 
addition of a psychologic intern. In addition to Drs. Jaflfe and Atoynatan, seven 
members of the house staff treat children under supervision. Two residents from the 
Spring Grove State 1 lospital and from the Springfield State Hospital, one resident from 
the Sheppard Pratt Hospital, and three child psvchiatrists from the community work 
at the clinic. The therapists receive careful supcrxision and attend frccjuent diagnostic 
and case conferences. 

During 1956, 206 patients were seen with a total of 2736 hours spent in face to 
face interviews; 175 requests were referred to other agencies (several children vxere 
referred to the Psychiatric Institute for treatment). This aspect of our program will be 
held in abeyance until Ward 4G is opened for the Children's in-patient service. In 
treating patients, intensive psychotherapv is being supplemented by abbreviated 
methods of indixidual treatment and by the use of group activity and group therapy 
methods for children of diflFerent ages. The work with parents includes group therapy 
and guidance. Research in the development of standardized therapeutic methods and 
on the mother-child interaction is under way. 



140 iit/LLET/i\ OF THE SCllOOl ()/ MEDICINE, U. Of AID. 

MENTAI IlVC'.lLNli SOCllIN t'llNlC: 1 OU C'llllDUHN 

The Mental I Ixgiene SocietN Clinic lor C'hiklren was set up as a special elinie run 
jointly h\ the Departments of Peiliatries anil Ps\ehiatr\ in the Petliatrie Out patic-nt 
Department. I he purpose ol the elinie was to oiler ser\ iee to the Department ol 
Pediatries, to pediatricians, and to the comnuinit\ , with emphasis on caring lor the t\ pe 
ot patient which would tail within the domain ol the petliatrieian. Phe Mental 1 hgiene 
Society ot Greater Baltimore, Inc. undertook io pro\ ide the sum ol $2S,000 a Near tor 
H\'e years to supjiort the prolessional personnel in the clinic. 1 he clinic was opened in 
lanuarv, 1954, with a staff of a haH time psxehiatrist, a lull time ps\chologist, .intl a 
psvehiatrie social worker. Fhc clinic is uiuler the direction ol Dr. Mar\ in |alle. 

Since it has heen open, the clinic has heen treating an increasing numher of 
children, ahout half of whom haxe heen referred from the Department of Pediatrics 
and the other half from the jiediatricians in the eommunit\. There ha\e heen many 
e\aluations antl consultations w ith social agencies in the communit\. The intake [H)lic\ 
has continued to he that ol accepting children up to 12 \ears of age referred hy parents 
at the suggestion of pediatricians or other jihx sicians working with children. In addition 
to clinical ser\ ice, the clinic has heen \ er>' acti\e in teaching, and se\eral research 
projects ha\e been started. 

During the past year the clinic has liad a total of 177 referrals, 63 from the 
pediatric clinic, 64 from pri\ ate practicing pediatricians, the remaining 50 from other 
out-patient clinics and general practitioners. A total of 133 patients, 75 hoys and 58 
girls, have been treated, most of these being between the ages of 5 and 10. About 60 
per cent of those referred are children with beha\'ior disorders, the remainder having 
psychosomatic problems, mental defleienc\' or brain damage. Approximately half of 
these had been seen as long-term treatment eases bein^ treated for six months or longer, 
the rest ha\e been seen for diagnostic studies and brief therapy. /\s of May, 1957, we 
ha\e 53 in actixe treatment at the clinic and 44 awaiting cxaluation. 

A sul:)stantial amount of stalf time is spent in teaching third and fourth year medical 
students, pediatric residents, and pediatric interns, junior and senior metlical students, 
while on the pediatric ser\ ice, spend time in lecture and discussions in the clinic. Ihe 
emphasis in these discussions is on what the pediatrician can do himself and what 
shoidd be relerred to a psxehiatrist. Consideration is gi\en to the emotional factors and 
attitudes which pla\ a role in the doctor patient situation antl in the parent-child 
situation. 

Pediatric residents also rotate through the clinic and are given the opportunitN of 
observing interviews and psychologic testing. The work with patients is done inider 
supervision. The resident is encouraged to bring up jiroblems from his own pediatric 
experience for discussion. Supervision is aimed at enabling the pediatrician to appreciate 
those methods, teehnic|ues and de\'iees which are useful in practice. 

1 he stall members ol the clinic ha\c been acti\e in consultation w ith [pediatricians 
in several settings. Dr. Claser attends the Well-Babv Clinic and also \isits on the 
pediatric wards. Drs. Cdaser and /\to\ natan haxe been especially interested in hos- 
pitalized children with psychosomatic problems. 



DEPARTMENT OF PSYCHIATRY 141 

A series of night meetings each month ha\e been organized to which local private 
practicing pediatricians ha\'e been inxited. This year several topics such as reading 
disabilities, problems of adoption, and juvenile delinquency have been the subject of 
an evening's discussion. These meetings have been well attended by pediatricians as 
well as bv social workers, psychologists, and students. 

Section IV 
RELATIONS WITH OTHER INSTITUTIONS 

University Hospital 

Our work in the rest of the hospital consists primarily of clinical work and under- 
graduate and graduate teaching. Since 1951, we ha\'e had an acti\e consultation ser\ice 
for ward and for pri\ ate patients. At present the ward consultation work is under the 
direction of Dr. Klaus Berblinger. During the current \ear 140 consultations were seen. 
The breakdown according to ser\ices requesting consultation is as follows: medicine 
72 per cent, surgerv 9 per cent, obstetrics and neurologv 6 per cent each, neurosurgerv 
and pediatrics 2 per cent each, and gynecology, urologv, genitourinary service 1 per cent 
each. 

Dr. E. T. Lisansky has been of great help in teaching emotional factors in medical 
disease. It has been our experience that the teaching of emotional and personality factors 
in the etiologv of disease, and in the treatment and management of patients is much 
more effectixe when done by the physician who has the o\'er-all responsibilit\ for 
patient care. Dr. Lisansky s invoh'ement on Ward 3G and in the first and fourth year 
teaching has made him invaluable as a teacher of medical students. With the coopera- 
tion of Dr. Woodward, an Assistant Resident in Medicine spends one month on ward 
3G. Dr. Julian Reed has strengthened our liaison with the Department of Medicine. 

We have been grateful for the opportunity of working with Dr. Charles Van- 
Buskirk. During the past year he has been generous with his time and his talent in 
teaching and in clinical work. He has been helpful to Dr. Grenell in discussing joint 
problems and has undertaken some investigative work with Dr. Callaway. During 
1956-57, Dr. VanBuskirk ga\e a review course in clinical neurologv attended bv our 
resident staff and has supervised one of our assistant residents rotating in his di\ision. 
He has been active as a consultant on 3G. Dr. Jerome Merlis has been interested in 
our work and is collaborating with Dr. Grenell in research. 

The Department of Medicine has cooperated in our fourth year teaching program. 
In 1950, Dr. Pincoffs first gave us permission to have our fourth year students in 
psvchiatrv work with patients on the medical wards. This program has continued with 
the collaboration of Dr. Woodward. 

Our relations u ith the Department of Surger\- were informal up to two years ago 
when Dr. Nathan Schnaper was assigned to the surgical service as a part-time con- 
sultant. Dr. Schnaper attends surgical rounds, sees surgical consultations and is available 
for teaching. We would like to expand our clinical ser\ices in surgery and evcntualK 
should like to in\ite surgery to have an assistant resident rotate through ward 3G. Dr. 
Kent Robinson, in 1954, was assigned as a consultant to the obstetric and gynecologic 



142 BULLETIN OF THE SCHOOL OF MEDICINE, 11. OF MD. 

scrxiccs. I lis duties are to attend stall' meetings aiul to he axailable to the students and 
house staff lor psvehiatrie eonsultations. Dr. Hohinson has long been interested in the 
emotional problems of these patients and is an exeellent teaeher. This year Dr. Charles 
Betts expandetl this aspect ol our program. 

We ha\e enjoyed an aetixe and produetixe eollaboration xvith Dr. J. Edmund 
Bradlex and his staff. He has shown great interest in our Child Guidance Clinic, and 
has eneoiuaged us to work on the pediatrics wards and clinics. We hax'e been able to 
receix-e support Irom the Mental Hygiene Societx' ot Greater Baltimore, Inc., for a 
child guidance clinic in the Pediatric Department, under the joint direction of Pedi- 
atrics and Psxchiatrv. Dr. Bradley has been a collaborator in pur study of the emotional 
factors in children xvith poliomyelitis— a project supported by the National Foundation 
of Poliomyelitis. Pediatric residents rotate through the Child Guidance Clinic and last 
X'ear we had a joint residency in pediatrics and psychiatry. Child psychiatry is taught 
students as part of the teaching programs of both departments. We have applied for 
additional teaching funds from the National Institute of Mental Health for the support 
of two fellowships for pediatricians during one year of training in child psychiatry. We 
look forward to much more collaboration when the psychiatric in-patient ward for 
children is opened. 

In 1951, Dr. Huntington Williams invited Dr. Finesinger to participate in his 
course on public health given to the fourth year class. The sessions consisted of a 
discussion of reports on home visits by the students. Subsequently this course was 
expanded into hax'ing every student make a home visit and report to the group. In 
1953-54, a program was worked out with psychiatry so that this course could be gix'en 
during the time the students were in psychiatry. We felt that this was an opportunity 
for relating psychiatry to public health and preventix'e medicine. When Dr. Pincoffs 
became Professor of Prex'entix'e Medicine, this program was tied in with the Medical 
Care Program and has continued as such. At present, a group of twelve students spend 
one afternoon a week in discussing the reports made by their colleagues on their visits 
to patients in the family care program. This program is attended by Mrs. Imogene 
Young, and other members of our department. 

Departvient of Psychology 

During the past four years we have had an active liaison with the Department of 
Psychology at College Park. A program was arranged with Dr. Bishop of the Student 
Health Service for our Department to furnish consultation service in psychiatry to the 
Student Health Service at College Park. Dr. Marion Mathews, Instructor in Psychiatry, 
spends one halt day a week working direcdy with the psychologists, in the Student 
Counselling Program in seeing students and patients. We should like to expand this 
program and include training and experience in counselling as part of our Residency 
Training Program. Since the Psychology section in our department has been accredited 
for training of clinical psychologists we are working out a joint program with the 
Department of Psychology. 

The geographic proximity of the professional schools on the Baltimore campus has 
made it possible for the Institute to undertake joint teaching and research programs 



DEPARTMENT OF PSYCHIATRY 143 

with several professional schools. We have been working with the School of Law, and 
the School of Nursing. 

School of Law 

During the past two years we have been collaborating with several members of the 
facultv of the Law School on a program concerned with the interrelated problems of 
Medicine and Law. In 1953, Dr. Manfred Guttmacher, Chief Medical Officer in 
Psychiatrv of the Supreme Bench, was appointed Associate Clinical Professor in our 
department. With the help of Dean Howell and Professor Whitting Farinholt, a joint 
elective course was given to senior students in the School of Law in 1954-55. Drs. 
Finesinger, Guttmacher, and Lisansky and other members of the Department of 
Psychiatrv participated in a similar course last year. Additional time was allowed for 
the law students to visit the Psvchiatric Institute and to observe interviews with patients. 
In February a public lecture was given by Dr. Herbert Wechsler, Professor of Law, at 
the Columbia Universitv, sponsored jointlv by the School of Law and bv the Psychiatric 
Institute. 

School of JNiirsing 

Since 1950 the department has participated in the teaching of undergraduate and 
graduate nurses. Dr. William Fitzpatrick, Dr. Charles Bagley, Dr. Greenhill, and Dr. 
Finesinger have given undergraduate courses in the School of Nursing and in the 
College of Special and Continuation Studies. One of the major interests of the depart- 
ment has been to define the roles of ancillary personnel in the treatment team. During 
the present academic year our seminars with nurses ha\'e focused on a clearer delinea- 
tion and definition of the nurse's role. Several of the theses of the students working 
towards their master's degree in nursing, deal with this topic. Dr. Finesinger and Miss 
Fernandez are jointly interested in this area. We have felt that our work wath the 
School of Nursing is productive in the areas of nursing education; it is also useful in 
attracting nurses of high quality for service in the Institute. During the first semester 
of 1956-57, a series of seminars was held bv Dr. Finesinger with the students who are 
working for a master's degree in psvchiatric nursing in the graduate program. During 
the current semester, Drs. Reid, Grenell, and Callaway are leading seminars with 
students for the master's degree. 

Department of Public Health 

We are working on several projects in collaboration with the State Department of 
Public Health. During the past five years we have been conducting a joint program 
on the in-service training in mental health for public health nurses. This program is 
under the direction of Miss Florence M. Burnett, who holds appointments in the School 
of Medicine and in the State Department of Public Health. The In-Ser\'icc training 
program attempts to increase the nurse's awareness and understanding of human 
behavior, to develop skill in the use of interpersonal techniques, and to work out ways 
and means of evaluating the nurse's training. Miss Burnett is working on methods for 
describing the nurse's performance in the field and evaluating changes in her behavior 
in an attempt to determine the effectiveness of the methods of teaching. Each month a 
group of six nurses spend one week in the Psvchiatric Institute for instruction. This 



144 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

group has been previously observed by Miss Burnett in the course of their work in the 
counties. After a period of training thev are again observed at work. On the basis of 
these observations, attempts are made to cxaluate the effectiveness of the program. 
Since this program was started at least 200 nurses ha\c particijiatcd and \arious types 
of exaluation studies ha\c been undertaken. 

The State Department of Public Health which supports our clinic for alcoholic 
patients described in Section I, has been interested in setting up seminar meetings and 
workshops at the institute for psychiatrists and other personnel working in alcohol 
clinics throughout the State. In 1955-56 a special workshop was held with the collabora- 
tion of Mr. Joe Bellinger, of the State Service. Dr. Roger Waterman has had a series 
of weeklv meetings with the probation officers of the Supreme Bench of Baltimore at 
the Psychiatric Institute. These meetings have been seminars on methods of dealing 
with specific problems shared by the probation officers. Dr. Klaus Berblinger has been 
a consultant at the tuberculosis hospital at Mt. Wilson for the past two years. He has 
been visiting weeklv as consultant, and has held a series of seminars on the problems 
of patients with tuberculosis and on the psychiatric factors in the treatment and 
management of patients with tuberculosis. 

State Departuieut of Mental Hygiene 

One of our major responsibilities has been to work with the hospitals and the 
programs of the State Department of Mental Hygiene. Dr. Finesinger is secretary to 
the Advisory Board of the Mental Hygiene Department by virute of his position at the 
University of Maryland. Many members of the State Department hold appointments 
on our staff. Dr. George Sutherland, an Associate Professor in our Department, is in 
charge of education and research in the State system. Dr. Isadore Tuerk, Superin- 
tendent of the Spring Grove State Hospital, Dr. Irene Hitchman, Clinical Director of 
Springfield State Hospital, and Dr. Charles Ward, Superintendent of the Crownsville 
State Hospital, are on our staff and collaborate on our teaching program. Our third and 
fourth year students do some of their psychiatric work at the State Hospitals where 
there is an opportunity for examining and studving a variety of psvchiatric patients. 
The chief advantage of the State Hospitals for undergraduate teaching is that it is 
possible for students to assume complete responsibility for the studv and care of many 
types of patients. At present, during the third year, groups of three students take a three 
week clerkship at the Spring Grove and Springfield Hospitals. The teaching staff at 
these hospitals is supervised by members of our own staff who go out with the students 
to the hospitals and help organize their programs. 

Our staff and students have participated in teaching and in research projects at the 
State Hospitals. Mr. Philip Vail, Instructor of Medical Psychology, teaches our students 
at the State Hospitals methods of dealing with disturbed patients. Dr. Enoch Callaway, 
Assistant Professor of Psychiatry, has been consulting with Dr. Kurland on the effects 
of thorazine and serpasil and other drugs on psychotic patients. Dr. Berblinger, Associate 
Professor of Psychiatry, has been conducting a series of seminars during the past year 
at Springfield State Hospital. Dr. Virginia Huffer has been teaching third year students 
and participating in resident teaching at the Spring Grove State Hospital. 



DEPARTMENT OF PSYCHIATRY 145 

We have tried to bring State Hospital people into our own department as teachers 
and workers. Dr. Berblinger has been conducting a clinic every Wednesday e\'ening 
vi^hich is set up primarilv for State Hospital psychiatrists. As many as ten to fifteen 
State Hospital psychiatrists come to the University and treat patients under supervision. 
Dr. Isadore Tuerk, Superintendent of Spring Grove State Hospital, is consultant to 
our clinic for alcoholic patients in which individual and group therapy is used. He has 
visited our wards and has conducted a seminar on psychotherapy in manic patients. 
We are making tentative plans for work on the social structure of the famih' in 
connection with a projected study at the Rosewood Training School. A research club 
has been organized by Dr. Finesinger for discussions of continuing ps\chiatric projects 
in the State and other Psychiatric Hospitals. The first meeting of this group was held 
in June, 1957. Dr. Finesinger has been an active consultant at the Rosewood Training 
School in an attempt to help with its program. 

Section V 
RESEARCH PROGRAM 

The research program has expanded in many areas during 1956-1957. We have been 
fortunate in receiving continued support from national and local organizations, without 
which our program would be extremely limited. During the past year our total support 
from non-university sources has been approximateh' S320,000 of which approximateh' 
$32,000 has been allocated to the University of Maryland as overhead. 0\'er 60 per cent 
of these funds are allocated for research projects (see Table I). These funds ha\'e been 
useful in bringing into the department trained investigators who ha\'e been helpful in 
the service and teaching programs and have been instrumental in building up an 
atmosphere of inquiry and research. 

Our major research interests lie in understanding the factors which make for mental 
illness and maladjustment, in the ways and means of curing and helping people with 
mental illness, and its prevention. Dr. Grenell's work on brain metabolism, biochemistry 
and neurophysiology and Dr. Callaway's work on perception and the automatic ncr\'ous 
system represent one aspect of our efforts in correlating the physical and biochemical 
with the psychologic factors. The work on drugs with Drs. Klee and Silverstein leads 
into studies in psychology and sociology which are also exemplified by the studies of 
Drs. Libo, Pope, Finesinger, and Robinson on group psychology and on the teaching 
process. The broader interest in xalues and psychiatric theory are seen in the work of 
Dr. Reid. A brief description of the major research areas follows. 

BIOCHEMICAL STUDIES 

This work has been carried out under the direction of Dr. Robert Grenell. He has 
been assisted this year by a full time staf? of Dr. Leopold May, Mr. Elmar Einberg, Mrs. 
Nancy Eidman, and a part-time staff of Mr. Myron Wolbarsht, Mr. Daniel Sax, Mr. 
D. Brown, and Dr. Mitoji Miyazaki. This program has been supported primarily bv 
grants from the National Institute of Mental Health, the Office of Naval Research, 
and the U. S. Air Force Research and Development Command. A brief account of the 
more recent phases of the work is given below. 



146 BULLETIN OF THE SCHOOL OF MEDICINE, V. OF MD. 

Adeuos'uietriphosphate (A.T.P.) and Chlorpromazi}ie Studies. The most recent 
developments in this area are concerned with cell fractionation. Pieces of brain from 
control rats, and trom rats injected with chlorpromazine are centrifuged at high speed 
so that neurons are broken into four layers. These layers are not complete]) pure 
fractions, but b\ nature of the majority of their contents are referred to as nuclear, 
mitochondrial, microsome and supernate. ATP was measured in each fraction. It was 
found that the increase in ATP occurred in the microsome la\er. This is of particular 
interest since existing e\ idence indicates that the microsomes are concerned in protein 
synthesis. Since previous experiments showed that chlorpromazine causes a decrease in 
cerebral ribosenucleic acid (RNA), it becomes reasonable to suppose that the system 
involved in the eneruv changes (associated with the ATP increase) mav be an enzvme 
svstem which is an essential part of the protein svnthetic mechanism. As a further step 
in these studies, measurements of glutamin-oxaloacetic-transaminase reaction ha\e been 
made on brain homogenates in the control and chlorpromazinized animals. The 
transaminase is not significantly inhibited by the chlorpromazine. 

Recent work on the energv and electron transport factors has concerned measure- 
ments of Diphosphopvridine nucleotidase (DPXase) seen in the hypothalamus (rela- 
ti\e to the concentration in other areas). It is felt that this is related to the transfer of 
acetyl radical and not merely to the destruction of Diphosphopvridine nucleotide 
(DPN). 

MalououitriJe. Further work has been done on the ultra-violet studies of neurons 
from animals injected w ith malononitrile. The induced qualitative intracellular changes 
(presumabh) caused bv an increased nucleoprotein were reported in 1956, but only 
recently has it been possible to obtain quantitative data. The microdensitometric 
measurements leave no doubt that "aged" aqueous malononitrile solutions dramatically 
increase neuronal density (at 260 and 280 m). 

Insidin Studies (in collaboration with Dr. Merlis). Recent experiments have shown 
that following systemic injections of shock amounts of insulin it is possible to record 
at least three simultaneous cerebral responses not related to blood sugar levels. The 
findings show: (a) an increase in the cortical response to direct electrical stimulation; 
(b) a decrease in the evoked auditory cortical response to a click stimulus; (c) no 
significant alteration in the response of the medial geniculate body to the click. 

It would appear that the decreased cortical auditory response is not the result of a 
direct effect of insulin on the auditor)' system. (These results suggest that the effect of 
insulin is indirectly intracortical.) On this basis it may be postulated that the insulin 
effect is on a center of a lower anatomic level in the central nervous svstem (CNS)— a 
center which projects fibers up to the cortex. These fibers ha\e a special role to play in 
the response of the cells to afferent input. In other words, there is the possibility that a 
mechanism exists here which is basic for normal sensory discrimination and perception 
in the organism. 

Analysis of Post-Mortevi Brain. Studies are being carried out on pieces of brain 
left standing in air, nitrogen, or in the dead animal for increasing periods of time. The 
post-mortem tissue is being used to follow progressive anoxic-anemic chemical charges 
in the cells. Two important observations have been made: (a) although there is a steady 
decline, ATP in significant amounts is still measurable as much as thirty minutes after 



DEPARTMENT OF PSYCHIATRY 147 

death; (b) glutamin-oxaloacetic-transaminase is still at the normal level three hours 
after death. 

ReJatioyishtp Between Antonoviic Activity and Perception. Dr. Callaway's group 
has continued their work on the problems of perception (narrowed attention) and the 
factors which account for changes in the state of awareness. This work has been carried 
out with the assistance of Dr. Klee, Dr. Jones, Mr. Parker, and Mr. Alexander. The 
work has been supported in part by the U. S. Public I iealth Service and by the Army 
Chemical Center. Some of the studies are listed below. 

Studies on time in perception. An investigation designed to detect periodic dis- 
continuity in attention. 

Drug studies. Continued investigation of effects of drugs on cognitive and per- 
ceptual functions. 

Patient studies. Preliminarv studies on correlations between clinical status, measure 
of autonomic function, measures of perceptual functioning and measures of cognitive 
functioning. 

Alcohol project. Comparison of alcohol, meprobamate, and methamphetamine as 
drugs influencing cognitive and perceptual functioning. 

Studies in the psychopharviacolooy of mttweg. These have been carried out in 
collaboration with Dr. John Krantz of the Department of Pharmacology. 

STUDIES IN PSYCHOPHARMACOLOGY 

These studies have been carried out bv Drs. Klee, Silverstein, Jones, Finesinger, 
Callaway, and Mr. Alexander. They are part of a project supported by the U. S. Army 
Chemical Center. 

Studies in the Reaction to Specific Chemical Agents. The major part of the work 
is done at the Army Chemical Center in cooperation with professional personnel at that 
installation. Studies are being made of the effects of certain pharmacologic agents upon 
normal human vcjlunteers. The areas studied include group interaction and individual 
performance on psychomotor tasks and on psychological tests. During the course of the 
year, three papers were written and sexeral talks were given at the Armv Chemical 
Center by members of the group. The material dealt with is classilled, and it is not 
possible to elaborate any further on the details of the work. 

Antagonistic Effect of heuzyl substituted Anti-Serotonin (BAS) on Lysergic acid 
diethylamide 25 (LSD-25) in Humans. The study was designed to evaluate the possible 
relationship between the effect of LSD-25 and serotonin metabolism. The subjects were 
studied clinically and by means of psychological tests. The results indicate that BAS has 
no effect on the LSD-25 reaction. 

THE ADJUSTMENT OF CHILDREN WITH POLIOMYELITIS 

This is the fourth year of our study on the emotional, situational, personalitx and 
sociologic factors, and their role in the treatment, disabilitv, and the recoxerv process 
in patients with ]X)liomvelitis and their families. The members of the j^roject are Drs. 
Robinson, Bierman, Silverstein, and Mr. Greenblum. 1 his project is supported by the 
National Foundation for Infantile Paralysis. Drs. Finesinger and Bradley are the 
principal investigators. 



148 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

The major effort in this project has been the study of a series of poliomyeHtis 
patients and their famihes from the onset of the ilhiess until twehe months after the 
date of discharge from the convalescent hospital. A second group of patients, initially 
seen during the summer season of 1955, were studied. In 1956-57, careful longitudinal 
and cross-section studies haxe been made in a large number of families and on children 
with paralytic poliom\ elitis. This material is now being de\ eloped and a series of papers 
is in preparation for publication. Semi-annual progress reports ha\ e been submitted to 
the National Foundation for Infantile Paralysis since December, 1953. 

In addition to these studies, the ancillary studies listed below have been conducted: 

The reyresentatton of Physique in Children's Figure Drawings. A follow-up study 
of a previously published in\'estigation, designed to test the validity of human figure 
drawings as projections of body image. (Robinson & Silverstein) 

Attributes of Savie-Sex and O'pposite-Sex Characters in Thematic Perception. A 
test of certain assumptions employed in the interpretation of the thematic apperception 
test and related projective techniques. (Silverstein) 

Puhlication Trends in Abnormal, Clinical, and Couuseliug Psychology: 1948-57. 
A study of shifting interests as reflected in the literature of the past ten years. (Silver- 
stein) 

A Psychoaiiah'tic Study of the Nox'cl Frankenstein. An attempt to relate elements 
in this storv with the necrophilic interests of its author, Mary Shelley. (Bierman) 

Social Mobility and Political Attitiides. The relation of types of mobility to attitudes 
and ideologies that have been considered relevant to the political process. (Greenblum) 

STUDIES IN THE TEACHING AND LEARNING PROCESS IN MEDICAL STUDENTS 

The department has been interested in studying the teaching and the learning 
process in medical students and in graduate physicians. Several papers ha\e been read 
and published dealing with descriptions of class behavior, set learning, and the relation 
between teaching and psychotherapy. The current studies are part of a pilot project 
on the assessment of the undergraduate and graduate teaching of psvchiatrv at the 
School of Medicine, University of Maryland and the Psychiatric Institute of the 
University Hospital (Finesinger, Robinson, Pope, Davis, Silverstein, Howe). This is 
a pilot study supported by the National Institute of Mental Health. 

Two major problems are being investigated. The first study is the teaching of 
interviewing to medical students and graduate physicians. Students are trained to carry 
out goal-directed interviews with patients. Skill in interviewing is measured and the 
changes in the student's performance are used to assess the methods of teaching. 

The second study is concerned with the teaching and assessment of the student's 
clinical perception. We are using the Finesinger-Powdermaker series of sound films as 
a teaching and measuring instrument. By means of various measures, the student's 
performance is evaluated before and after specific instruction to determine change in 
acuity and breadth of perception (reading between the lines). These changes are 
related to the performance of the student, course performance, and other more effective 
criteria. Further correlation will be attempted between changes in perception and 
attitudes and attitude changes. This material is to be related to a study by Dr. Libo on 
the factors associated with the choice or rejection of psychiatry as one's medical specialty. 



DEPARTMENT OF PSYCHIATRY 149 



PSYCHOTHERAPY 



Studies in individual and group psychotherapy have been carried on by Drs. Libo, 
Dunlap, Klee, and Glaser in an attempt to solve some of our clinical and in-patient 
problems. A partial list includes: 

Studies in gro2ip therapy (Klee and Liho). A group of psychoneurotic patients have 
been seen weekly in psychotherapeutic sessions. Social and psychologic studies have 
been carried out in this group to determine what changes take place in learning the 
patient role and in group attraction and cohesiveness as therapy progresses. 

Changes in parents xvho participate in group discussion {Dunlap). This study is 
being carried out with the Mental Hygiene Society. The major variable under study is 
the parents' awareness of interpersonal factors involved in children's problems. A 
reliable research instrument was developed and tried out on a small scale in one group 
of parents. Other instruments have been developed for an evaluation of mothers' 
attitudes by a study of responses to sentence completion blanks (Dunlap); and for a 
study of the effectiveness of group discussions with student nurses. (Dunlap and 
Glaser). 

STUDIES IN PSYCHOLOGY 

Drs. Pope and Libo have as their ongoing researches: 

Continuation of work on the index of pathologic thinking (Pope). This index is a 
rating scheme based on a content analysis of deviant verbalizations in response to the 
Rorschach. Pursuant to the publication of initial findings, the manual is now being 
revised in preparation for further studies. 

Development of an incomplete sentence test for clinical use (Pope, Libo, and 
Remy). 

De\'elopment of a social psychologic theory defining the psychotherapeutic process 
and a methodologic framework with which the theory can be tested (Libo). 

Development of a rating scale for describing patient behavior in indi\'idual psycho- 
therapy (Libo, Joseph, Pope). 

Table I 
DEPARTMENT OF PSYCHIATRY 

List of Projects Supported by Outside Agencies (1956-1957) 
In Support of Research 

1. U.S.P.H. Pilot and Evaluation 

2. National Foundation for Infantile Paralysis 

3. Arm\' Chemical Center 

4. U.S.P.H. Career Investiaator 

5. National Institutes of Health 

6. Office of Naval Research 

7. United States Air Force 

8. National Research Council, Alcohol 

9. Sadacca Fund 

Total: Annual Grants $202,861 

Overhead $ 26,312 



150 BilLLETlS OF THE SCHOOL OF MEDICINE. U. OF MD. 

U.S.P.H. Teach'nig Grants 

1. LI.S.P.M. Clinical Psychology 

2. U.S.P.H. Li ndergraduate Grant 

3. U.S.P.H. Graduate Grant 

4. LI. S.P.I 1. C.raduate Traineeships 

Total : Annual Grants S 96,742 

Overhead $ 5,675 

III Support of CUfiics 

1. Maryland State Public Health Alcohol Clinic 

2. Mental Hygiene Society Child Guidance Clinic 

Total: Annual Grants $ 21,700 

Lectureships 

Etta and Myer Dana Fund 

Total Support from Outside Agencies— 1956-57 

Annual Grants $320,203 
Overhead $ 31.987 

Total Support from Outside Agencies— 1955-56 

Annual Grants $248,110 
Overhead S 27,829 

Total Support from Outside Agencies— 1954-55 

Annual Grants S28 1,668 
Overhead $ 27,829 

FRIDAY MORNING STAFF CONFERENCES- 1956-1957 

October 5 "Collaborative Treatment of the Family Group in a Behavior Problem 

in Adolescence" 

Jean M. Covle, M.D., Fellow in Psychiatry; Joan H. Remy, Assistant 
in Medical Psychology; Charles Baglev, III, M.D.; Associate in Psy- 
chiatry, School of Medicine, University of Maryland, Baltimore, 
Maryland 

October 12 "Gender Role: The Evidence of Human Hermaphroditism" 

John L. Hampson, M.D., Asst. Professor of Psychiatry, The Johns 
Hopkins Medical School, Baltimore, Maryland 

October 19 "Anthropology and Psvchiatr\ " 

Clyde K. Kluckhohn, Ph.D., Professor of Anthropology, Harvard 
University, Cambridge, Massachusetts 

October 26 "The Mental Hospital as a Total Institution" 

Frying Goffman, Ph.D., Laboratory of Socio-Environmental Studies, 
National Institute of Mental Health, Bethesda, Maryland 

November 2 "Program and Projects of the Mental Hygiene Society Clinic for 
Children " 

Mar\in Jaffe, M.D., Assistant Professor of Psychiatry; and Staff, 
Mental Hygiene Society Clinic for Children, School of Medicine, 
Uni\'ersitv of Maryland, Baltimore, Maryland 



DEPARTMENT OF PSYCHIATRY 



151 



November 9 "The Nature of Messages in the Communication in Community 
Meetings" 

Harry A. Wilmer, M.D., Naval Medical Research Institute, National 
Naval Medical Center, Bethesda, Maryland 

November 16 "Prenatal and Paranatal Factors in the Development of Childhood 
Behavior Disorders" 

Benjamin Pasamanick, M.D., Professor of Psychiatry, Ohio State 
University, College of Medicine, Columbus, Ohio 

November 30 "The Cultural Origin of Neurotic Family Interaction" 

John P. Spiegel, Research Associate, Laboratory of Social Relations, 
Harvard University, Cambridge, Massachusetts 

December 7 "On the Nature of Sexual Excitement" 

Frank A. Beach, Ph.D., Sterling Professor of Psychology, Yale Uni- 
versity, New Haven, Connecticut 

December 14 "Changes in Familv Interaction with the Development of Mental 
Illness" 

John A. Clausen, Ph.D., Chief, Laboratory of Socio-Environmental 
Studies, National Institute of Mental Health, Bethesda, Maryland 

December 21 "English Psychiatry Today" 

Anthony Hordern, M.B., MRCPED., MRCP, DPM, Assistant in 
Psychiatrv, School of Medicine, University of Maryland, Baltimore, 
Maryland 

January 4 "Limitations of Psychiatry" 

Leo H. Bartemeier, M.D., Medical Director, Seton Institute, Balti- 
more, Maryland 

January 11 "The Focus of Attention, A Dimension of Personality that mav be 
Modified Physiologicallv" 

Enoch Callaway, M.D., Assistant Professor of Psychiatry, School of 
Medicine, LIniversity of Maryland, Baltimore, Maryland 

January 18 "Some Recent Development in the Study of Body Motion, Language 
and Psychiatry' (Illustrated bv film) 

Ray Lee Birdwhistcll, Ph.D., Associate Professor of Anthropology, 
University of Buffalo, Buffalo, New York 

January 25 "Improving the Social Acceptance and Participation of Rejected Chil- 
dren: An Experimental Studv of Four Therapeutic Strategies" 

Ronald Lippitt, Ph.D., Professor of Psychology and Sociology, and 
Program Director, Research Center for Croup Dynamics, Uni\-ersitv 
of Michigan, Ann Arbor, Michigan 

February 1 "An Experimental Approach to the Analysis of Emotional Bchaxior " 
Joseph V. Bradv, Ph.D.. Chief, Department of Psxchologw W^ilter 
Reed Army Institute of Research, Washington, D. C. 

February 8 "Some Problems of Body Image ' 

Douglas Noble, M.D., Consultant in Psxchiatrv, U. S. Naval Hos- 
pital, Bethesda, Mar\'land 



152 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF AID. 

February 15 "The Mental Hospital as a type of Organization" 

Talcott Parsons, Ph.D., Professor of Sociology, Harvard Llniversit)-, 

Cambridge, Massachusetts 
March 8 "The Relationship of the Therapist to the Outcome of Therapy in 

Schizophrenia" 

Barbara J. Betz, M.D., Associate Professor of Psychiatry, The Johns 

Hopkins University, Baltimore, Maryland 
March 15 "Preliminary Experiments on the Effects of Sleep Deprivation" 

David McK. Rioch, M.D., Director of Neuropsychiatry Division, 

Walter Reed Armv Institute of Research, Washington, D. C. 
March 22 "Inferring the Strength of Certain Human Drives and Their Sympto- 

matic Signficance 

John Richard Wittenborn, Ph.D., Llni\ersity Professor of Psychology 

and Education, Rutgers University, New Brunswick, New Jersey 
March 29 "Some Special Aspects of the Care of the Adolescent" 

}. Rosvvell Gallapher, M.D., Chief of the Adolescent Unit, Children's 

Hospital, Boston, Massachusetts 
April 12 "Some Recent Experimental Studies of Deficit Behavior in Schizo- 

phrenia" 

Norman Garmezv, Ph.D., Psychologist, Training and Standards 

Branch, National Institute of Mental Health, Bethesda, Maryland 
April 26 "Some Obser\'ations on Schizophrenia" 

Lewis B. Hill, M.D., Chief of Psychiatry, Sheppard and Enoch Pratt 

Hospital, Towson, Maryland 
May 3 "Some Observations on Schizophrenia" (second in a series of three talks) 

Lewis B. Hill, M.D., Chief of Psychiatry, Sheppard and Enoch Pratt 

Hospital, Towson, Maryland 
May 10 "Studies in Human Cerebral Function: Prolonged Stress and the 

Highest Integrative Functions of Man" 

Harold G. Wolff, Professor of Medicine, Cornell Llniversitv Medical 

School, New York City, New York 
May 24 "Functions and Goals of a Comprehensive Medical Out-Patient Clinic"' 

W. Sidney Easterling, M.D., Associate in Psxchiatrv; and Panel, 

School of Medicine, Uni\ersity of Maryland, Baltimore, Maryland 
May 31 "Some Observations on Hysteria" (last in a series of three talks) 

Lewis B. Hill, M.D., Chief of Psychiatry, Sheppard and Enoch Pratt 

Hospital, Towson, Maryland 
June 7 "The Optical Analysis of Nervous Tissue" 

Leopold May, Ph.D., Instructor in Psychiatry, School of Medicine, 

University of Maryland, Baltimore, Maryland 
June 14 "The Nature of Emotion" 

Harlev C. Shands, M.D., Associate Professor of Psychiatry, The 

Uni\ersity of North Carolina, Chapel Hill, North Carolina 
June 21 Staff discussion of Friday morning conferences. 



DEPARTMENT OF PSYCHIATRY 153 

PUBLICATIONS 1956-1957 

BiERMAN, J. and May, E.: Necrophilia, Maryland Association of Private Practicing Psychiatrists 

Prize for Research, 1957. In Press. 
BiERMAN, J.; SiLVERSTEiN, A. and FiNESiNGER, J. E.: A depression in a six year old boy with 

acute poliomyelitis, Submitted to the Psychoanalytic Study of the Child. 
Callaway, E.: Editorial— On the production of hallucinated and psychosis-like states, Ann. Int. 

Med., 42: 721, 1954. 
Callaway, E. and Van Buskirk, C: Observations on vibratory thresholds, Confinia Neurological 

16: 6, 301-308, 1956. 
Callaway, E.: Institutional use of ataractic drugs Modern Med. 25: 81 (Jan. 15) 1957. 
Callaway, E. and Finesinger, J. E.: Uncertainty as a measurement of psychopharmacology, 

Jour, of Amer. Soc. for Clin. Invest., 1956. 
Davis, F. : Definitions of time and recovery in paralytic polio convalescence, Amer. Jour, of 

Sociology, LXI: 6, 1956. 
Finesinger, J. E.: The era of research, Proceedings of the Fourth Annual Psychiatric Institute, 

N. J. Neuro-Psychiatric Institute, Princeton, N. J., 35-45, 1956. 
Glaser, K.; Patterson, P. R.; Lipton, E. L. and Unna, K. R.: Dosage of drugs in infants and 

children, III. Neostigmine, Pediatrics, 18: 31, (July) 1956. 
Glaser, K. and Eisenberg, L.: Mat?rnal deprivation. Pediatrics, 18: 626, (October) 1956. 
Grenell, R. G. : Mechanisms of actions of psychotherapeutic and related drugs. Annals N. Y. 

Acad. Sci.; 66: 826-835, 1957. 
Grenell, R. G. : Considerations regarding metabolic factors in the actions of chlorpromazine in 

Tranquilizing Drugs, Symposium Monograph published by AAAS (Public. No. 46) Wash- 
ington, D. C, 1957. 
Grenell, R. G. : Nucleic acids in selected brain areas. Neurology, 1957 (in press). 
Grenell, R. G. and May, L. : Infra-red spectroscopy of nervous tissue. Introductory studies, J. 

Neurochem, 1957 (in press). 
Grenell, R. G. and May, L.: Infra-red spectral studies of tissues. Annals N. Y. Acad. Sci., 1957 

(in press). 
Grenell, R. G.: Molecular structure and functional activity of ner\'e cells, Monograph published 

by Amer. Inst. Biol. Sci., Ed. by R. G. Grenell and L. J. MulHns, 1957. 
Grenell, R. G.; May, L. and Finesinger, J. E.: Considerations concerning the mechanisms of 

actions of drugs on nerve cells. Trans. Am. Neurol, Assoc. 138, 1956. 
LiBO, L. : The Picture Impressions: A Projective Technique for Investigating the Patient-Therapist 

Relationship. (Manual; packet of pictures, Forms M & F; instructions; answer sheets.) 

Department of Psychiatry, School of Medicine, Univ. of Md., 1956. 
LiBO, L.: The projective expression of patient-therapist attraction. Journal of Clinical Psychology, 

13: 33-36, 1957. 
LiBO, L.: Authoritarianism and attitudes toward socialized medicine among senior medical 

students. Social Psychol., 1957 (In Press). 
Pope, B. and Jensen, A. R. : The Rorschach as an index of pathological thinking. Jour, of Proj. 

Techniques, 1957, 21: 54-62. 
Pope, B.: Supervision in the training of clinical psychologists. Paper read at Springfield State 

Hospital Symposium. To be published in: Finn, J. & Brown F. Training in clinical psychology. 

International Universities Press, 1957. (In Press). 
Pope, B.: Attitudes toward group therapy in a psychiatric clinic for alcoholics. Quarterly Journal 

of Studies on Alcohol, 17: 233-254, 1956. 
Reid, John R.: The concept of unconscious anxiety and its use in psychotherapy, Am. J. Psycho- 
analysis, 16: 42, 1956. 
Robinson, H. and Finesinger, J. E.: A framework for the psychopathology of poliomyelitis. The 

Nervous Child, II: Number 2, 10-17, (January) 1956. 
Robinson, H. and Finesinger, J. E. : The significance of work inhibition and work restriction 

for rehabilitation. Journal of Social Work (accepted for publication). 



154 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD 

Robinson, H.; Finesinger, J. E. and Bierman, J.: Psychiatric considerations in the adjustment 

of patients with poHomyelitis, New Eng. 254: Number 21, 975-981, (May) 1956. 
Robinson, H.: Review of Derner, F. Aspects of the psychology of the tuberculous, Bulletin of the 

Medical Library Association, 1954. 
Robinson, H.: Hospital adjustment problems of poliomyelitis patients, Nursing World, 10-15, 

(May) 1956. 
Silverstein, a. and Robinson, II.: The representation of orthopedic disability in children's 

figure drawings. Journal of Consulting Psychology, 20: Number 5, 333-341, (October) 1956. 
TuERK, I.: Mothers Who Destroy Children. "A Program for the Treatment of Alcoholics in a 

State Hospital." In Press, RELEASE, Department of Mental Hygiene. 
Waterman, R.: A course for probation officers. The National Probation and Parole Association 

Journal, (April) 1957. 
Young, I. S.: Some attitudes and responses of medical .students, in The Psychiatric Social Worker 

Teaches Medical Students, The National Association of Social Workers, pp. 1-64, 1957. 
Young, I. S.; Large, D.; Meuser, M. and Seltzer, N. R. : Statement on teaching by a regional 

committee, pp. 14-20. 
Young, L S. and After, N. S.: Parata.xic distortion and history taking: An experimental method 

in teaching junior medical students. Am. J. of Psychiat., 113: No. 3, (Sept.) 1956. 

SPEECHES AND ADDRESSES 

by members of the Institute Staff 
July 1, 1956-June 30, 1957 

Mental Hygiene: Greek Orthodox Church of the Annunciation, Baltimore, Maryland, November, 

1956. Dr. T. H. Atoynatan. 

History of Psychiatry: Greek Orthodox Church of the Annunciation, Baltimore Maryland, Decem- 
ber, 1956. Dr. T. H. Atoynatan. 
Parent-Child, Teacher-Pupil Relationship and the Education of Primary School Children: St. 

Nicholas Greek Orthodox Church, Baltimore, Maryland, February, 1957. Dr. T. H. Atoynatan. 
On Alcoholism: Memorial Methodist Church, Catonsville, Maryland, April, 1957. Dr. T. H. 

Atoynatan. 
Graduation Address to Occupational Therapy Aides: Crownsville State Hospital, Crownsville, 

Maryland, November, 1956. Dr. Charles Bagley III. 
Mental Health Today: Unitarian Church, Baltimore, Maryland, February, 1957. Dr. Charles 

Bagley III. 
Mental Health Today: Eastern Star, Baltimore, Maryland, March, 1957. Dr. Charles Bagley III. 
The Role of the Psychiatric Institute in the Care of Emotionally Disturbed Children: Baltimore 

Chapter, National Association of Social Workers, Baltimore, Maryland, April, 1957. Dr. 

Charles Bagley III. 
Discussion of Mental Health Problems with Business and Professional Leaders in the Community: 

Moderator at five luncheon meetings at Merchants Club and Southern Hotel, Baltimore, 

Maryland, April, 1957. Dr. Charles Bagley III. 
Mental Health Program, WBAL Baltimore: Panel Member, Baltimore, Maryland, May, 1957. 

Dr. Charles Bagley III. 
Allergy (Panel discussion): Maryland Otolaryngological Society, Baltimore, Maryland, January, 

1957. Dr. Klaus W. Berblinger. 

Discussant of Doctor Jerome Frank's paper at Esther Richards Memorial Meeting: Maryland 
Psychiatric Society, Baltimore, Maryland, April, 1957. Dr. Klaus W. Berblinger. 

Problems of Adolescence, Panel discussion with Judge Carter: Baltimore, Maryland, March, 1957. 
Dr. Klaus W. Berblinger. 

Brief radio address concerning Mayor D'Alesandro's "Guard Your Health Week": Baltimore, 
Maryland, March, 1957. Dr. Klaus W. Berblinger. 



DEPARTMENT OF PSYCHIATRY 155 

Necrophilia: Maryland Assoc, of Private Practicing Psychiatrists, Baltimore, Maryland, 1957. 
Prize for research. Dr. Joseph Bierman and Miss Emily May. 

Applied Psychology: Course at College of Special and Continuation Studies, University of 
Maryland, September-February, 1956-1957. Miss Florence Burnett. 

Human Relations: Series of 15 seminars for student nurses at Lutheran Hospital, September- 
December, 1956. Miss Florence Burnett. 

Supervision in the Growth and Development of the Nurse: Workshop in Teaching and Imple- 
mentation of Psychiatric-Mental Health Nursing, Catholic University of America, Washington, 
D. C, June, 1957. Miss Florence Burnett. 

A Practical Application of Information Theory in Psychopharmacology: Eastern Regional Con- 
ference of the American Psychiatric Association, Philadelphia, Pennsylvania, November, 1956. 
Dr. Enoch Callaway. 

Stress and Human Behavior: Association of Female Personnel Workers, Baltimore, Maryland, 
November, 1956. Dr. Enoch Callaway. 

Participant in Panel Discussion on the Normal Personality: V. A. Regional Conference, Baltimore, 
Maryland, May 21, 1957. Dr. Enoch Callaway. 

Certification and Licensure: Participant and representative, Maryland Psychological Association 
at Workshop, Baltimore, Maryland, Aug.-Sept., 1956. Dr. Ralph Dunlap. 

Problems of Certification and Licensure: Conference of State Psychological Associations, Chicago, 
Hhnois, Sept., 1956. Dr. Ralph Dunlap. 

Psychiatrists for Mental Health Programs: Panel Discussant, Southern Regional Educational 
Board, Daytona Beach, Florida, August, 1956. Dr. J. E. Finesinger. 

The Era of Research in Psychiatry: 4th Annual Psychiatric Institute, New Jersey Neuropsychiatric 
Institute, Princeton, New Jersey, September, 1956. Dr. J. E. Finesinger. 

The Emotional Problems of the Cancer Patient: Maryland League for Nursing, Baltimore, Mary- 
land, October, 1956. Dr. J. E. Finesinger. 

Keynote Speaker: Regional Conference, U. S. Veterans Administration Hospitals, on Psvchiatry 
in the General Hospital, Waco, Texas, November, 1956. Dr. J. E. Finesinger. 

The Use of Hypnosis in Medical Practice: (Panel discussant), Conference of Mental Health, 
Representatives of State Medical Associations, Chicago, Illinois, Nov., 1956. Dr. J. E. 
Finesinger. 

The Teaching of Third and Fourth Year Psychiatry: Association of Southern Professors of Psy- 
chiatry, Washington, D. C, December, 1956. Dr. J. E. Finesinger. 

The Significance of Work Inhibition and Work Restriction for Rehabilitation: New England 
Council of Social Agencies, Boston, Massachusetts, Dec, 1956. Dr. J. E. Finesinger, (with 
Dr. H. A. Robinson). 

Keynote Speaker: Regional Conference, U. S. Veterans Administration Hospitals, on Psychiatry 
in the General Hospital, Dublin, Georgia, February, 1957. Dr. J. E. Finesinger. 

The Use of Placebos: Discussion of paper by L. Lisagna, Baltimore Psvchiatric Society, Baltimore, 
Maryland, February, 1957. Dr. J. E. Finesinger. 

The Role of Social Service in a General Hospital: Women's Board, Johns Hopkins Hospital, 
Baltimore, Maryland, March, 1957. Dr. J. E. Finesinger. 

The Family and Mental Illness: Workshop, Chairman of Panel Discussion, Psychiatric Institute, 
Baltimore, Maryland, April, 1957. Dr. J. E. Finesinger. 

Stages in the Creative Process: Chairman, Panel Discussion, Psychiatric Institute, Baltimore, 
Maryland, April, 1957. Dr. J. E. Finesinger. 

The Patient Faces Cancer: S^anposium sponsored by American Cancer Society and National 
League for Nursing, Chicago, May, 1957. Dr. J. E. Finesinger. 

The Integrated Role of the Psychiatrist and Social Worker: Panel discussant, Annual meeting. 
The American Psychiatric Association, Chicago, Illinois, Mav, 1957. Dr. J. E. Finesinger. 

The Psychiatric Social Worker in Medical Education: Chairman, Luncheon Meeting, Social 
Service Committee, The American Psychiatric Association and American Association of Social 
Workers, Chicago, Illinois, May, 1957. Dr. J. E. Finesinger. 



156 mil IFTI!^ or run school of medicine, 11. OF MD. 

Treatment of Psvchosoniatic Disorders: Meeting on therapy sponsored hy Carrier C'linic, Princeton, 

New Jersey. June, 1957. Dr. J. E. Finesinger. 
The Teaching ol First Year Psychiatry: University of Maryland Medical Alimini Association, 

Baltimore, Maryland, June. 1957. Dr. J. E. Finesinger. 
The Pre-School C'liild and DciiiKiuencv: Panel Member, Workshop of Second Governor's C'on 

ference on Juvenile IX-lincjuencv, College Park, Maryland, Sept., 1956. Dr. Kurt Claser. 
Behavior Characteristics of the Pre-School C'hild: P.T.A. of Kindercraft Kindergarten, Baltimore. 

Maryland, Sept., 1956. Dr. Kurt Claser. 
The limotionallv Healthy Child and How to Keep Him So: Child Study Association of Baltimore. 

October, 1956. Dr.' Kurt Claser. 
The Adjustment of Handicapped Children: Anne Arundel County Flealth Department, Associa- 
tion of Handicapped Children, Annapolis, November, 1956. Dr. Kurt Claser. 
How to be More Effective Parents: Women's Club of Johns Hopkins LTnixersity, Baltimore. 

Maryland, November, 1956. Dr. Kurt Claser. 
Juvenile Delinquency: Evening meeting for pediatricians, Auspices of Mental Hygiene Society 
Clinic for Children. Psychiatric Institute, Baltimore, Maryland, November, 1956. Dr. Kurt Claser. 
The Negativistic Phase: Children's Guild, Inc., Parent Discussion, Baltimore, Maryland, January, 

1957. Dr. Kurt Glaser. 
What Children can Benclit most from Attending tiie C'liildrcn's Ciuildr: Meeting of Directors of 

Nursery Schools of Baltimore at C'iiildren's Guild. Ixdtimore, Maryland, January. 1957. Dr. 

Kurt Glaser. 
School Phobia: Evening meeting for pediatricians, auspices of Mental Hygiene Society Clinic for 

Children, Psychiatric Institute, Baltimore, Maryland, January, 1957. Dr. Kurt Glaser. 
Jealousy: Children's Guild, Inc., Parent Discussion, Baltimore, Maryland, February, 1957. Dr. 

Kurt Glaser. 
What is the Nature of the Trainable Child?: Participant in Symposium, Maryland Society for 

Mentally Retarded Children, Inc., Workshop, ilaltimorc. Maryland, February, 1957. Dr. 

Kurt Glaser. 
Preschool Problems: Chairman, panel discussion, Children's Ciuild, Inc., Baltimore, Maryland, 

February, 1957. Dr. Kurt Glaser. 
Spoiling: Children's Guild, Inc., Parent Discussion, Baltimore, Maryland, March, 1957. Dr. Kurt 

Glaser. 
Adolescence: Evening meetings for pediatricians, auspices of Mental Hygiene Society, C'linic lor 

Children, Psychiatric Institute, Baltimore, Maryland, March, 1957. Dr. Kurt Glaser. 
Children's Anxieties: Parent Education Capsule Course, P.T.A. of Public School, Fallstaff Audi- 
torium, Baltimore, Maryland, March-April, 1957. Dr. Kurt Glaser. 
Mental Health and Prejudice: B'nai B'rith Women's Lodge, Baltimore, Maryland, April, 1957. 

Dr. Kurt Glaser. 
Spontaneous l^iscussions: C'liildrcn's Guild, Inc., i'arcnt Discussion, Baltimore, Mar\'lantl. April, 

1957. Dr. Kurt Glaser. 
The Father's Role in the Family: Northwest Cooperative Preschool Gn)up, rj.iltimore, Maryland, 

April, 1957. Dr. Kurt Glaser. 
When a Teacher has a Problem C'hild: State Teachers' C'ollegc, Towson. Ajiril, 1957. Dr. Kurt 

Glaser. 
Discussion on An.xietics in Teachers about Meeting Parents; Problems of School Phobia; Princi- 
pals, Parent Education Advisory Committee of Baltimore City Department of Education, 

Baltimore, Maryland, May, 1957. Dr. Kurt C»laser. 
Sex Education of Children of Elementary School Age: P.T.A. of Public School 218, Ixdtimore, 

Maryland, May, 1957. Dr. Kurt Glaser. 
Parent's Reactions to Children's Guild: Children's Guild, Inc., Parent Discussion, Baltimore, 

Maryland, June, 1957. Dr. Kurt Glaser. 
Nucleic Acid Analysis of Areas of the Brain: American Academy of Neurology, Brussels, Belgium, 

April, 1957. Dr. Robert Grenell. 



DEPARTMENT OF PSYCHIATRY 157 

The Effects of Insulin on Cortical Activity: International Physiological Congress, University of 

Aarhus, Denmark, August, 1956. Dr. Robert Grenell. 
Member of Panel on Problems of Alcohol: Springfield State Hospital, Sykesville, Maryland, June, 

1957. Dr. Robert Grenell. 
Problems of Adolescence: Panel Member, P.T.A. Baltimore Hebrew Conorewation, Baltimore, 

Maryland, October, 1956. Dr. Marvin Jaffe. 
Child Psychiatry: Tifereth Israel Brotherhood Breakfast, Baltimore, Maryland, December, 1956. 

Dr. Marvin jaffe. 
Child Psychiatry: Eutavv Place Temple P.T.A., Baltimore, Marvland, January, 1957. Dr. Marvin 

Jaffe. 
Discussant of talk of Dr. Reginald Lourie: Pediatric Section, Medical Chirurgical Facultv, Balti- 

more, Maryland, January, 1957. Dr. Marvin Jaffe. 
Three Papers Presented to Groups Visiting Army Chemical Center: Material deals with work 

done under Armv Chemical Corps Contract, DAT8T08-CML-5519, Edgewood, Marvland. 

Dr. Gerald Klee. 
Orientation in Psychiatry: High School Students, Bel Air High School, February, 1957. Dr. 

Gerald Klee. 
Orientation in Psychiatry: Several groups of high school students, college students, and group of 

school teachers. Psychiatric Institute, Baltimore, Maryland, June, 1957. Dr. Gerald Klee. 
Community Mental Health: Participant in Seminar, Johns Hopkins University School of Public 

Health, Baltimore. Maryland, 1956-57. Dr. Lester M. Libo. 
Guest Lecturer: Spring Grove State Hospital, Catonsville, Maryland, May, 1957. Dr. Lester M. 

Libo. 
Management of Psychosomatic Hall: Kecoughatan Veterans Hospital, Newport News, Virginia, 

February, 1957. Dr. E. T. Lisansky. 
Comprehensive Evaluation of Medical Problems: Wilmington Veterans Hospital Facility, Wilming- 
ton, Delaware, April, 1957. Dr. E. T. Lisansky. 
Medical, Psychiatric and Psychological Teamwork in the Evaluation of Medical Prcjblems: Fort 

Howard Veterans Hospital, Baltimore, Maryland. Dr. E. T. Lisansky. 
Psychosomatic Evaluation and Management of Medical Problems: North Virginia Clinical As- 
sembly, Alexandria, Virginia. Dr. E. T. Lisansky- 
Anorexia Nervosa: Case Reports with Differential Diagnosis and Management, Medical Research 

Club of Baltimore, Baltimore, Maryland. Dr. E. T. Lisansky. 
Comprehensive Medicine: York County Medical Society, York, Pennsylvania, May, 1957. Dr. 

E. T. Lisansky. 
Infrared Spectral Studies of Tissues: New York Academy of Science, December, 1956. Dr. 

Leopold May. 
Infrared Tissue Studies: Baltimore-W^ishington Spectroscopy Society, Washington, D. C, Febru- 
ary, 1957. Dr. Leopold May. 
The Rorschach Test As An Index of Pathological Thinking: American Psychological Association, 

Chicago, Illinois, September, 1956. Dr. Benjamin Pope (with Dr. R. Jensen). 
Index of Pathological Thinking: Baltimore Clinical Psychology Association, Baltimore, Maryland, 

November, 1956. Dr. Benjamin Pope. 
Comprehensive Medical Care of Patients: Fort Howard Veterans Hospital, Baltimore, Maryland, 

I3ccember, 1956. Dr. Benjamin Pope (with Dr. E. Lisansky). 
The Psychologist in Comprehensive Medicine: Alexandria Medical Society, Alexandria, Va., April, 

1957. Dr. Benjamin Pope. 
Supervision in the Training of Clinical Psychologists: Springfield State Hospital Sykesville, 

Maryland, May, 1957. Dr. Benjamin Pope. 
Freud And Our Discontents: A.A.A.S. And American Pliilosophical Association, New York, 

December, 1956. Dr. John R. Reid. 
Psychoanalysis, Logic and Philosophy: Academy of Psychoanalysis, Chicago, Illinois, May, 1957. 
' Dr. lohn R. Reid. 



158 BULLETIN OF THE SCHOOL OF MEDICISE. U. OF MD. 

Ps^•ch^atric Nosologv. Problem of Logical Analvsis: American Psychiatric Association, Chicago, 
' May. 1957. I>r. John R. Reid. 

Social Class and PsA'chiatr\': Baltimore Sociers' of Private Practitioners, Baltimore, Mar}'land, 
August. 1956. Dr. H. A. Robinson. 

Problem and Stratagems in Interdisciplinary Research: Rutgers Univ. Colloquium, New Bruns- 
wick. N. J.. Sept., 1956. Dr. H. A. Robinson. 

Social Stratification and the Practice of Psvchiatry: Phipps Chnic. Johns Hopkins Hospital, October, 

1956. Dr. H. A. Robinson. 

The Arvpical Child: Rutgers Universitv, Seminar, New Brunswick. New Jersey, February', 1957. 

Dr. H. A. Robinson. 
Mental Hvgiene: W'ellwood Parent Teachers .Association, 1957. Dr. Nathan Schnaper. 
Prut^am on Pain: (T\'-MD) under auspices of Postgraduate Committee. School of Medicine, 

Universitv of Mar\land, 1957. Dr. Nathan Schnaper. 
Parents .Are People Too: Cockevs\'ille Adult Education Group of Homemakers, FebruaiA', 1957. 

Miss Bonnie Strain. 
Fihn on Mental Health: Discussion Leader. Towson \^'omen's Club, November, 1956. Miss 

Bonnie Strain. 
Ps\chiatric Social Work in Child Guidance Chnics: Senior Ps}'chology class, Goucher College, 

November. 1956. Miss Bonnie Strain. 
Mothers \Mio Destroy Children: Medical Research Club, Baltimore, Maryland, Januarv, 1957. 

Dr. Isadore Tuerk. 
A Program For The Treatment of Alcohohc Patients in a State Hospital: Department of Mental 

Hygiene, State of Massachusetts. Mav, 1957. Dr. Isadore Tuerk. 
Psychotherapeutics As AppUed to Schizophrenic Patients: Seminar, Post-Doctoral Training Insti- 
tute, Di\ision of Clinical Ps\chologA" of the American Ps^xhological Association, Northwestern 

Universitv. Evanston, IlHnois, August, 1956. Dr. Otto A. Will. 
Psychotherapy and the Schizophrenic Patient: Galesburg State Research Hospital, Galesburg, 

lUinois. August, 1956. Dr. Otto A. Will. 
Ps\chotherapv as Evolved from Observations of the Schizophrenic Reaction: Neurops%chiatric 

Societ\- of Virginia and District Branch of American Psvchiatric Association, Roanoke, \'irginia, 

October, 1956. Dr. Otto A. Will. 
The Onset of Schizophrenia with Imphcations for Ps^•chotherapy: Edward T. Gibson Lecture, 

University- of Kansas School of Medicine, October. 1956. Dr. Otto A. Will. 
Psychotherapy of the PsNchoses: Connecticut Postgraduate Seminar in Ps%xhiatr\' and Neurology, 

Middletown, Connecticut, Januarv, 1957. Dr. Otto A. Will. 
The Nature of Schizophrenia: Universit\- of Virginia Medical School, Charlottes\'ille, Virginia, 

JanuarA'. 1957. Dr. Otto A. Will. 
The Therapy of Schizophrenia: Universits' of \'irginia Medical School, Charlottes\-ille, Virginia, 

Januar)', 1957. Dr. Otto A. Will. 
The Problem of Schizophrenia: 3 lectures at St. Elizabeths Hospital, Washington, D. C Spring, 

1957. Dr. Otto A. Will. 

Psychotherapy and the Hospitalized Patient: 6 lectures at the Spring Grove State Hospital, 

Catonssille, Mar\land. Spring, 1957. Dr. Otto A. Will. 
Discussion of paper, "The PsAchotherapv of Schizophrenia": Bv W. Abse. Mav, 1957. Dr. Otto 

A.Will. 
Discussion of paper, "Problems in Initiating Psychoanalytic Ps\'chotherapv of a Schizophrenic 

Following Hospitalization": by A. DWmore, May, 1957. Dr. Otto A. Will. 
Discussion of paper, "Family Participations in Schizophrenia": Murrav Bowen and Warren Brodv. 

Annual Meeting, American Ps\xhiatric Association, May, 1957. Dr. Otto A. WQl. 
Ps\xhotherapy and the Schizophrenic Reaction: Veterans Administration Mental Hvgiene Clinic. 

Philadelphia, Penns^'lvania, June. 1957. Dr. Otto A. Will. 
The Schizophrenic Reaction: U. S. Naval Medical School, Bethesda. Md., June, 1957. Dr. Otto 

A. Will. 



niil'AHTMENT OF PSYCJIlArHY 159 

Inteqiretation of ;i Mental I lyj/ienc S(Kicty Clinic Function: Episcopal Women's (jroup, fJaltimore, 

Maryland, IJcccnibcr, 1956. Miss Margaret Wilson. 
The Emotionally I lealthy Cliild: Methodist Women's Group, J'altiiDorc, Maryland, February, 

1957. Miss Margaret Wilson. 
Interpretation o( Mental I lygiene Society Cllinic Function: C.I.O. Executive Hoard, IJaltimore, 

Maryland, March, 1957. Miss Margaret Wilv>n. 
Interpretation of Mental Hygiene Society (ilinic function: Mental F lygiene Society of Cireater 

Baltimore Vrdunteers, F5altimore, Maryland, May, 1957. Miss Margaret Wilv>n. 
The Emotionally Healthy I're School Child: May, F957. Miss Margaret Wilson. 
I he Mental F lygiene Society Program: Televised Prrjgram with Dr. K. Glaser and \)r. \\. Uiinlap, 

HaltiiTiore, Maryland, June, 1957. Miss Margaret Wilvjn. 
I lie Integrated \\(>\c of the I'sychiatrist and S'>cial Worker: I'anel F^iscussant, Annual Meeting of 

the Anierican F'sychiatric Association, Cihicago, Fllinois, May, 1957. Mrs. Fmogene S. Young. 
( hairnian and discussion leader of meeting on "Supervision in the Psychiatric Setting": \ational 

Conference of Social Welfare, Philadelphia, Pa., May, 1957. Mrs. Imogene S. Young. 
Discussant, "F'sychiatric Social Workers in Medical Fiducation": F^uncheon meeting, Social Service 

Committee of the American Psychiatric Associatif)n, and the American Asvjciation of Social 

Workers, Chicagf), Illinois, 1957. Mrs. Imogene S. Young. 
Chairman, Wftrkshop on "The Family and Mental Fllness": Psychiatric institute, Haltimore, 

Maryland, April, 1957. Mrs. Imogene S. Young. 



DEPARTMENT OF RADIOLOGY 

Organization and Ideology 

The Department of Radiology is organized into two divisions: (1) the Division of 
Diagnosis and (2) the Division of Radiation Therapy. The Department of Radiology 
has always been primarily a service organization but during the past four years more 
emphasis has been placed on teaching and research which are now considered major 
responsibilities of this Department. 

Faculty and Staff 

John M. Dennis, M.D Professor and Head 

Charles N. Davidson, M.D Professor of Clinical Radiology (P.T.) 

Fernando G. Bloedorn, M.D Associate Professor of Radiology and 

Head, Division of Radiation Therapy 

Robert P. Boudreau, M.D Assistant Professor (on leave of absence 

for advanced study of Neuroradiology— 
England and Sweden 

Carlo A. Cuccia, M.D Assistant Professor 

Lloyd M. Bates Radiation Physicist— Assistant Professor 

James A. Lyon, M.D Associate 

Herbert L. Warres, M.D Instructor (P.T.) 

Nathan B. Hyman, M.D Instructor (P.T.) 

Raul Mercado, M.D Instructor (effective 7T-57) 

Teaching 

During the past four years there has been increased emphasis on teaching, particu- 
larly at the undergraduate medical student level. During this time a short course (12 
hours) in roentgen anatomy has been included in the first year gross anatomv course 
and it is planned to further expand this course by the addition of functional anatomv 
as demonstrated by cine-radiography. A lecture demonstration course, formerly given 
during the fourth year, has been shifted to the third year and replaced bv a clinical 
clerkship in the fourth year. 

Research 

As with teaching, greater emphasis has been placed on research during the past 
two years. Prior to organization of the Division of Radiation Therapy, research in the 
Department was entirely of a clinical nature; and while it is still mainlv on a clinical 
level, some basic research, particularly on radiation dosage and distribution, is being 
]ierformed. 

The following research problems are being investigated in this Department. 
Sources and amount of financial supi^ort for se\'cral of these research projects are 
indicated. 

1. Radiation Therapy in the Treatment ot Urinary Bladder Cancer. 

a. Investigation and Evaluation of Established Radiation Methods. 

b. Development of New Radiation Methods. 

161 



162 B17LLETZN OF THE SCHOOL OF MEDICINE, V. OF AID. 

Supported by an $11,988 grant from the National Institute of Health, with an additional 
$7,000 per year for the next two years. 

2. Radium Implants: Development of a System of Distribution, Dosage Calculations and Rules 
of Application for Combinations of Geometrical Patterns of Radium Implants Applied in the 
Treatment of Advanced, but Still Curable Malignancy. 

Supported by a $10,000 grant from the American Cancer Society. 

3. The treatment of Multiple Papillomata of the Bladder by Radioactive Colloidal Isotopes. 
Supported by a $4,070 grant from the American Cancer Society, Maryland Di\'isi()n. 

4. Effects of Preoperative Irradiation in the Treatment of Carcinoma of the Breast. 

5. Preoperative Radical Irradiation (Cobalt-60) Plus Radical Surgery in the Treatment of 
Carcinoma of the Esophagus. 

6. Combined Approach of Preoperative Irradiation and Surgery in the Treatment of Broncho- 
genic Carcinoma. 

7. Combined Therapy (Cobalt-60) Plus Radical Surgery in the Treatment of Advanced Carci- 

noma of the Head and Neck. 

8. Significance of Subdural Air in Pneumoencephalography in Infants. 

9. Supervoltage Radiography in 

a. Pneumoencephalography. 

b. Chest lesions. 

10. Clinical Evaluation of Nephrotomography as a Diagnostic Procedure. 

Graduate Prooraui 

With the organization of the Division of Radiation Therapy during the past two 
years, the residency training program has been expanded to include se\'en residents, and 
an expansion to nine residents is contemplated for next year. The residency program 
includes two \'ears of radiologic diagnosis with six months in pathology, and one year 
of radiation therapy, including radium and other radioactixe isotope training. 

Dr. Donald /\. Wolfel has recei\'ed a six months' fellowship at the Radiologic 
Registry of the Armed Forces Institute of Pathology, eflFecti\'e July 1, 1957. 

Statistics 

Diagnostic Division 

Number of patients 41,703 

Number of roentgen examinations 55,146 

Therapy Division 

Number of treatments 7, 1 50 patient days 

Number of radium and radon implantations 179 

Number of patients with intracavitary radio-active instillations 15 

Facilities and Equipment 

The Department of Radiology has two separate physical facilities. The main depart- 
ment is located in the Hospital and is equipped for all types of routine and special 
diagnostic studies as well as radiation therapy. A smaller division, located in the Out- 
Patient Department, is equipped only for routine diagnostic studies. Special diagnostic 
studies and radiation therapy for clinic patients are performed in the main department 
in the Hospital on an appointment basis. 

At the present time the facilities of the Department are grossly inadequate, particu- 
larly in the Diagnostic Division. Recendy, however, a $301,000 construction bid was 
let for enlargement of the diagnostic area which will be completely air-conditioned and 
equipped with the new and the most modern equipment axailable, costing another 
S200,000. Included in the new equipment are: (1) a Schonander biplane angiographic 



DEPARTMENT OF RADIOLOGY 163 

unit capable of making eight exposures per second in each of two planes, (2) a body 
section unit capable of making body sections in both the upright and supine positions, 
(3) a cineradiographic unit for making motion pictures of the fluoroscopic image, (4) a 
new automatic processing unit, completely processing a film in six minutes, and (5) 
four new fluoroscopic-radiographic units complete with ceiling-mounted tube stands 
and automatic spot film devices. 

During the past year the Radiation Therapy Division has been expanded both in 
space and equipment. The Martha V. Filbert Radiation Therapy Center was established 
by the Filbert Foundation as a memoriam to Mrs. Martha V. Filbert. Contributions 
from the Women's Auxiliary of the Unixersity Hospital and the National Brewing 
Company assisted in the establishment of this therapy center, which was constructed 
in the basement of the Psychiatric Institute. A radioactive cobalt therapy unit with a 
650 curie radioactive source was installed. A new contact therapy unit (for Chaoul 
therapy) has been purchased and will soon be installed. The Therapy Division has also 
recently de\'eloped a localizing de\'ice for localizing tumors and portal directions. 

Couniiiiiiitv Service 

The Department of Radiology renders many community services in both its Diag- 
nostic and Therapy Divisions. The diagnostic unit in the Out-Patient Department 
renders a large amount of free service to the indigent and low-salaried patients who 
seek medical care in this area. The Diagnostic Division in the main hospital provides 
similar diagnostic studies for these patients and others after they have been hospitalized 
as well as to the private in-patients. 

The Division of Radiation Therapy renders the best medical care available in this 
State to all patients suftcring from malignancies. The radioactive cobalt teletherapy 
unit is the only supervoltage irradiator available in this area for treatment of the general 
public. Since its installation, the number of patients receiving daily treatment has 
increased approximately 150 per cent, and this number is continuously increasing. 

Puhlicatioiis—\956> 

Bloedorn, F. C: Application of the Paterson- Parker system in interstitial radium therapy, Ameri- 
can Journal of Roentgenology, Radium Therapy and Nuclear Medicine, March, 1956. 

Crosby, R. M. N. and Dennis, J. M.: Subdural collections of fluid in infants and children, I. 
Visualization of the capsule with thorium dioxide, American Journal of Roentgenology, Radium 
Therapy and Nuclear Medicine, September, 1956. 

Dennis, J. M.: Association of irradiation with neoplasia in children and adolescents. Editorial, 
Annals of Internal Medicine, March, 1956. 

Dennis, J. M.: Intravenous cholecystographv and cholangiography, Maryland State Medical 
Journal, March, 1956. 

Dennis, J. M. and Boudreau, R. P.: Pleuropulmonarv tularemia: Its roentgen manifestations. 
Radiology, January, 1957. 

Dennis, J. M. and Mercado, R.: Scurvy following folic acid antagonist therapy, Radiology, 
September, 1956. 

Dennis, J. M.; Workman, J. B. and Bauer, R. E.: Radioactive colloidal gold in the control of 
malignant effusions. Report and analysis of 60 patients, American Journal of Roentgenology, 
Radium Therapy and Nuclear Medicine, June, 1956. 



164 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

Papers Prese)ited—\956 

1. The Significance of Subdural Air in Pneumoencephalography in Infants— Robert P. Boudreau, 
M.D. Presented at Eastern Conference of Radiologists, Baltimore, Maryland, March, 1956, 
and at Eighth International Congress of Radiology, Mexico City, July, 1956. 

2. Treatment of Advanced Squamous Cell Carcinoma of the Head and Neck by Interstitial 
Radium Implantations— Fernando G. Bloedorn, M.D. Presented at the Eastern Conference of 
Radiologists, Baltimore, Maryland, March, 1956, and at Eighth International Congress of 
Radiology, Mexico City, July, 1956. 

3. Dionosil in Bronchography— Henry H. Startzman, M.D. Presented at Eastern Conference of 
Radiologists, Baltimore, Maryland, March, 1956. 

4. Pleuropulmonarv Tularemia: Its Roentgen Manifestations— John M. Dennis, M.D. Presented 
at Eastern Conference of Radiologists, Baltimore, Maryland, March, 1956. 

5. Diagnostic Problems of the Urinary Tract— John M. Dennis, M.D. Presented as a refresher 
course at the annual meeting of the American Roentgen-Ray Society, Los Angeles, California, 
September, 1956. 

PxecoDimeudatious for hiiprovevieiit 

The contract has been let and equipment purchased for the new addition to the 
Diagnostic Division in the University Hospital. The facilities in the Division of 
Radiation Therapy and in the diagnostic unit in the Out-Patient Department are far 
inadequate for handling the present patient-load. Plans have been submitted for 
expansion of each of these areas and it is hoped that this expansion will occur with 
the building of a new Out-Patient Department. 

In the new Out-Patient Department, plans for the expansion of the Division of 
Radiation Therapy will include such things as office space, a workshop, research 
laboratories, greater area for patient-care and super- and megavoltage irradiation equip- 
ment for handling anv and all tvpes of malignancy. 



DEPARTMENT OF SURGERY 

The Department of Surgery is one of the major divisions within the framework of 
the School of Medicine. In general, it is directed to the fulfillment of the same 
functions as any of the clinical departments within the School. It is composed of six 
divisions, General Surgerv, Orthopedic Surgery, Urologic Surgery, Neurologic Surgery, 
Thoracic Surgery and Otolaryngology. 

A sincere attempt is made by the physicians of these divisions to undertake the best 
service and most critical care of patients who seek from them diagnosis and surgical 
treatment of their disease. This is the role of every surgeon. Beyond this is the desire 
to teach students and young house officers a basic approach to the scientific study of 
disease and its surgical correction. In the course of this experience it is anticipated that 
a few chosen men will be encouraged to cultivate an attitude of critical inquirv, both 
basic and clinical, that mav contribute to the further knowledge of disease and the best 
manner and method of its cure. 

The full recognition of these ideals has brought about a fundamental change in 
the heretofore basic philosophy of this department. Whereas, its clinicians and teachers 
have all, in the past, devoted their time on a part-time basis, the majoritv of division 
heads are now directing themselves toward the practice of their specialty and their 
teaching and research inclinations on a full-time basis. Encouragement and support 
of this attitude by the Medical School has been most gratifying. 

During the tweh'e months preceding this report, the Department of Surgery has 
continued the process of change and reorganization begun two years ago. Much of 
this change has been silent and unnoticed for it lies within the thoughtful planning 
of the several members and Division Chiefs of the department and has as yet been 
impossible of achievement. A share of the disappointment and disillusionment has 
come from the inability to enlarge the clinical facilities of the several divisions to a 
point where patient load and turnover is great enough to support properly the training 
and teaching programs required of them. This is perhaps the most urgent problem 
before us in the coming year. Others include enlargement and improvement in opera- 
tion room service and techniques, impro\'ement in accident room service and facilities, 
increase in professional and non-professional personnel and increase in non-patient 
area for departmental allocation and use. 

Notwithstanding these deficits the department as a whole has made a concerted 
effort to enlarge its service to the people of Maryland, to improve and better its teaching 
contacts with the students of the medical school and to enhance and improve its teach- 
ing capacity to the young men and women seeking post-graduate experience under its 
guidance. 

General Surgery 

This is the largest division within the department. It carries the largest case load 
both within the hospital and in the out-patient unit. Its responsibilities are basically to 
care for the large number of patients whose illnesses do not lie within the provinces 
set forth rather specifically by the other divisions, and, most importantly, to train and 

165 



166 BULLETIN OF THE SCHOOL Of MEDICINE, V. OF MD. 

tc'.ich students, nurses antl house ollieeis the more basie and huulaniental aspeets oi 
disease, the diagnosis oF chsease and injur) , the manners and methods ol eare of siek 
patients. In the aecomphshment ol these goals it is responsible to a large extent lor the 
adequate preparation oi intern and residents for entrance into the other llelds ol 
surgical interest. These duties are lulfilled by two full-time staff members and a large 
number of part time surgeons who gi\e freely but in varying wa\'s and to \ariable 
degrees of their know ledge, time, interest and loyalty— their recompense is lor the most 
part calculated in terms of good and thoughtlul care of their patients and mature 
assistance when this is rec]uired. 

The teaching, training and research programs cnxisioncd b\ this di\ ision is a broad 
one which encompasses considerable knowledge and ability, for it encroaches to a 
varying degree upon the fields of internal medicine, pediatrics, gynecology, radiology 
and radiation therajiy, and sexeral others. Not the least of its ideals is to teach and 
become proficient in the thoughtlul, kindh, wise and patient care of sick people. 

Sporadic discussions have taken place on several occasions among members of 
the General Surgery Staff concerning some increase in patient load for the further and 
more thorough training of house officers. One direction these discussions have taken 
has been the assignment of two more senior men in training in the division to the 
Maryland State Prison in Baltimore. This institution has a recently constructed 75 bed 
hospital section, a well equipped operation room, roentgenologic unit, laboratories, and 
similar divisions. It is anticipated and hoped that this will become a focal area for 
surgical care of all patients from like institutions in the State of Maryland. The surgical 
care of these patients and the teaching of house ollicers and students in this area is under 
the supervision of Dr. Edwin H. Stewart, Jr., Associate in Surgery. 

One of the early steps taken to increase student and house officer contact with 
members of the General SurgcrN' Staff was to increase the full-time members of the 
Staff. In September 1956 we were joined bv Dr. Arlic Mansberger who has already 
become a splendid and most \aluable associate. Dr. Mansberger is a graduate of the 
School of Medicine, University of Maryland. I le finished his residency in Surgery at 
the University Hospital in 1954 and returned to us after the completion of a most 
\aluable two \'ears as Chief of the Medical Studies C^roup, Biophysics Division, C. W. 
Laboratories, Army Chemical Center, Maryland. 

Because of the growing need for more pinsicians trained in the diagnosis and 
surgical treatment of cancer, the National Cancer Institute, under the National Cancer 
Act, provides training grants for special training of physicians in suitable training 
centers. The University of Maryland has been designated one of these centers. Dr. 
Benjamin A. Addison, Resident in Surgery, was the recipient of this traineeshiji for 
the year 1956-57. 

In October, 1956 Dr. John R. Ilankins returned to the department as an Assistant 
Instructor assigned to the Research Laboratory. Dr. I lankins returned to this country 
after his tour of duty with the Armed Services assigned to the Near East. He remained 
with us until May, 1957 when he returned to the Shiraz Medical Center as Chief of 
Surgery in the Nemazee Hospital, Shiraz, Iran. 



DEPARTMENT OF SURGERY 167 

It is sometimes said that a teaching program at the graduate level, which does not 
change, but remains static year after year, is likely a barren one. During the past school 
year two new, but not original, innovations were made: 

(a) A small group of senior students were sent to South Baltimore General Hos- 
pital for one-half their surgical section period. The response and reaction of 
the majoritv of senior students who were thus assigned was adverse to this 
assignment And it seems proper to consider abandonment of this service. 

(b) The senior students assigned to the Unixersity Hospital services were privi- 
leged to assume the duties of an extern, alternatinti daily these duties with 
others of their immediate group. On the whole the students' response was 
reasonable, mature and worthwhile. It is hoped that this aspect of their surgical 
experience can be repeated again next year. 

(c) The junior student teaching program did not vary greatly from that of the 
prex'ious vear in its source of patient contact or in its \arietv of opportunities 
to learn for the student. On the other hand, greater effort was made bv the 
members of this staff to enhance their individual student contacts and to 
im])ro\e their teaching technic|ue. This effort has borne some fruit in terms of 
the student's res]:)onse and particularly in his increased appreciation and 
demonstration of act|iiired knowledge of surgery and the surgical specialties. 

(d) During the school \'ear the Audio-Visual committee of the Department of 
Surgery jirepared a weekly motion picture for presentation to the junior and 
senior students and the house staff for teaching and discussion of surgical 
diagnosis and treatment of various diseases. 

The teaching, training and research activities of this dix'ision have been served 

O' r> 

admirably through the availability of donations and collections allocated to various 
funds for the use within the dcj^artment. The fluids receixed during the past vear are 
listed: 

(1) Mrs. Catherine C. Fuller, Washington, D. C. 

$250.00-Surgical Research Fund 

(2) Dr. Jacob J. Greengrass 

$1,000.00— Surgical Research Equipment Fund 
(5^) Pangborn Foundation Fund, Hagerstown, Md. 

$1 8,000. 00-Surgical Research Fellowship 
(4) Residents' Surgical Fund 

$24,000.00 (Approximately) 

Were it not for these funds many of the small advances made in the past year could 
not have been possible. Funds accumulated in the Residents' Surgical Fund have been 
the largest source of income available and are collected from patient pre-paid insurance 
services. Some 37 per cent of this year's accumulation in this fund has been devoted 
to the support of house officers and student Fellows within the department. An approxi- 
mate 42 per cent has furnished, equipped and supplied the Surgical Research Labora- 
tory. Ten per cent of the fund has been applied to travel expenses for stafiF and house 
officers who have attended many of the major medical meetings over the countrv and 
to the supply of current surgical literature for the further education of housemen. 



168 BULLETIN OF THE SCHOOL OF MEDICINE, V. OF MD. 

It seems apparent that many oF the needs and acli\ ities ol the department and its 
various divisions would have been greatly limited without this ineomc source. 

The out-patient area has been subjected to considerable jihysical change within 
the past year. 1 here has been a relocation of the sjiace for minor operation procedures. 
This has afforded an improved staff supervision and has facilitated a closer-knit teaching 
unit. In addition to the part-time teaching staff assigned to this area, two to three house 
oflficers, a resident and one or two assistant residents, participate in the patient care and 
teaching responsibilities. The out-patient service has been imder the supervision of 
Dr. Edwin M. Stewart, Associate in the Department of Surgery. 

1 he General Surgery Division lias made minimal progress in the Research Lalxjra 
tory area. Much time and effort have been spent in developing the physical facilities 
in the Bressler Research Laboratory assigned to the division. The overall supervision 
of the Laboratory has been the responsibility of Dr. Bruce Armstrong. With the recent 
completion of these facilities, work progress has begun already on several projects 
relating to trauma, hemorrhagic sliock and wound healin". During the coming year 
an extensive, nation-wide survey is to begin on the effects of chemotherapeutic 
agents upon cancers of the breast, stomach and colon. This division of surgery has been 
chosen as one of the patricipants in this evaluation program. 

Following is a listing of the xarious research projects now under way in this 
division : 

(1) The effect ol hemorrhagic shock upon the intraeelliilar respiratory system 
(Dr. Buxton) 

(2) I Iiimoral factors injurious to the capillary vascular system in traumatic and 
hemorrhagic shock (Dr. Cireisman) 

(3) Surgery alone vs. surgery plus chemotherapy in: 

(a) Gastric cancer ^ 

(b) Cancer of colon and rectum I Drs. Buxton and Mansberger 

(c) Cancer of breast J 

(4) Conduction of nerve impulse in myelinated fibers (Dr. Esmond) (Awaiting 
grant request) 

(5) F.S.n. determinations as an index for treatment in ad\'anced breast cancer 
(Dr. Hull) 

(6) The relationship of adenosine-5-monophosphate to wound healing (Dr. Reyn- 
olds'" and Dr. Codington'") 

(7) Differential gastric excretion of porplnrin b\ patients with gastric ulcer and 
carcinoma (Dr. Addison,'" cancer trainee, under the direction of Drs. Figge 
and Mack) 

(8) A follow-up study of patients after simj^le closure of perforated peptic ulcer 
(Dr. Musavi*) 

(9) Recurrence rates after the \arious operations for correction of inguinal herniae 
(Dr. Scott'") 

* House Officer 



DEPARTMENT OF SURGERY 169 



GENERAL SURGERY 



Residents Assistant Residents (2 yr.) 
Addison, Benjamin A. Douros, Photios 

de Venecia, Nestor Foley, Michael 

Williamson, Robert Reynolds, Beverly 

Assistant Residents (3 yr.) Assistant Residents (1 yr.) 
Brady, Charles W. Bass, Haskell 

Codington, John B. Cox, Everard 

Musavi, Sahredin Gomez, Andres 

Reeves, Henry G. Himmler, Walter 

Scott, Roger Hojnoski, Waclavv 

LECTURES 

Dr. Robert W. Buxton 

1 . "Megacolon" 

Church Home and Hospital, Baltimore, Md. 
October 16, 1956 

2. "Thyroid Disease in Children" 

Southern Medical Association, Washington, D. C. 
November 12, 1956 

3. "Portal Hvpertension" 

St. Francis Hospital and Sanatorium, Long Island, N. Y. 
November 22, 1956 

4. "Treatment of the Post-Thrombotic Leg" 

Baltimore City Medical Society, Baltimore, Md. 
January 4, 1957 

5. "Portal Hvpertension" 

Fort Howard Veterans Hospital, Fort Howard, Md. 
April 24, 1957 

6. "Cylindromatous Tumors of Salivary Glands" 

Annual Meeting, Medical and Chirurgical Facultv, Baltimore, Md. 
May 1, 1957 

7. "Inflammatory Diseases of the Small and Large Intestine" 

West Virginia Academv of General Practice. Charleston, W. Va. 
May 5, 1957 

8. "Mucoepidermoid Salivary Gland Tumors" 

Vlth International Congress of Otolarvngology 
Johns Hopkins Hospital. Baltimore, Md. 
May 11, 1957 

9. "The Department of Surgery in the University of Maryland" 

Peninsula General Hospital, Salisbury, Md. 
May 20, 1957 



170 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

LECTURES 

Dr. Harry C. Hull 

1. "Paralytic Ileus" 

Church Home and Hospital, Baltimore, Md. 
May 2, 1957 

2. "Colon" 

Fort Howard Veterans Hospital, Fort Howard, Md. 
May 9, 1957 

3. "Breast" 

Fort Howard Veterans Hospital, Fort Howard, Md. 
May 16, 1957 

4. "Thyroid" 

Fort Howard Veterans Hospital, Fort Howard, Md. 
May 23, 1957 

5. "Gastric Ulcer" 

Fort Howard Veterans Hospital, Fort Howard, Md. 
June 6, 1957 

6. "Pancreas" 

Fort Howard Veterans Hospital, Fort Howard, Md. 
June 13, 1957 

7. "Surgery of the Spleen" 

Fort Hovyard Veterans Hospital, Fort Howard, Md. 
June 20, 1957 

8. "Jaundice" 

Fort Howard Veterans Hospital, Fort Howard, Md. 
June 27, 1957 

LECTURES 

Dr. Arlie R. Mansberger 

1. "Obser\ations in Experimental Mechanical Trauma" 

Management of Mass Casualties Course 

Walter Reed Army Institute of Research, Washington, D. C. 

September, 1956 

December 13, 1957 

March 28, 1957 

2. "The Role of Ballistic Phenomena in Wound Contamination" 
"Bacterial Factors in Irreversible Shock from Massive Soft Tissue Wounds" 

Army Medical Research Laboratories, Fort Knox, Kentucky 
January 21, 1957 

3. "Bacterial Factors in Irreversible Shock from Massive Soft Tissue Wounds" 

Wicomico County Medical Society, Wicomico County, Maryland 
March 11, 1957 ' 



DEPARTMENT OF SURGERY 171 

4. "The Correlation of Wound Bacteriology and Survival Time in Experimental 
Mechanical Trauma" 

Maryland National Guard (Medical Officer's Seminar) 
104th Med. Bn. Armory 
March 14, 1957 

5. "The Role of the Rural Physician in the Management of Mass Casualties" 

St. Mary's County Medical Society, St. Mary's County, Maryland 

6. "Bacterial Factors in Irreversible Shock from Massive Soft Tissue Wounds" 

House Staff— Union Memorial Hospital, Baltimore, Md. 
February, 1957 

7. "Bacterial Factors in Irreversible Shock from Massive Soft Tissue Wounds" 

House Staff— Church Home and Hospital, Baltimore, Md. 
June 5, 1957 

LECTURES 

Dr. E. R. Shipley 

1. "Physiology of Trauma" 

Academv of General Practice, Wilmington, Del. 

October 14, 1956 (Given by Drs. Shiplev and Sheppard) 3-4 hr. session 

2. "Peptic Ulcer" (Member of a panel) 

Naval Hospital, San Diego, California 
March, 1957 

LECTURES 

Dr. George H. Yeager 

1. "Thyroiditis" 

Southern Medical Association, Washington, D. C. 
November 12. 1956 

2. "Diverticulitis" 

South Eastern Surgical Congress, Richmond, Virginia 
October, 1956 

3. "Diagnosis and Treatment of Peripheral Vascular Disease" 

Church Home and Hospital, Baltimore, Md. 
January, 1957 

4. "Problems of Arterial Thrombosis and Vascular Prosthesis" 

Myers Clinic, Phillipi, West Virginia 
September, 1956 

Guest Speakers from the Department: Student Seminars— 1956-57 
Dr. Paul W. Sanger, Charlotte, N. C, November 3, 1956 

"Arterial Prostheses " 
Dr. Pcrrv B. Hudson, (Asst. Prof. Urology), Columbia University, New York. Novem- 
ber 17, 1956 

"Testicular Tumors" 
Dr. G. Burroughs Midcr, (Assoc. Director Cancer Research), National Cancer Insti- 
tute, Bethcsda, Maryland, January 12, 1957 



172 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

"Cancer of the Colon" 
Dr. W'm. VV. McKinney, Fort Worth, Texas, January 19, 1957 

"Surgical Treatment of Parkinson's Disease" 
Dr. George Crilc, Jr., Cleveland Clinic, January 26, 1957 

"Carcinoma of Breast, Thyroid and Colon" 
Dr. Murrax Al. Copeland, (Prof, of Oncology), Georgetown University Hospital, 
Washington, D. C, March 9, 1957 

"Tumors of Bone" 
Dr. Samuel F. Marshall, Lahey Clinic, Boston, March 16, 1957 

"Cancer of the Stomach" 

SPECIAL LECTURES 

Mr. R. H. O. B. Robinson, Senior Surgeon and Urologist, St. Thomas' Hospital, 
London, England, May 1, 1957 

"Carcinoma of Male Genitalia" 
Mr. H. Gordon Ungley, Gordon Hospital, for Rectal Diseases, London, England, June 

10. 1957 

"Diagnosis of Rectal Cancer" 

PUBLICATIONS 

Buxton, R. W.: Thyroid disease in children, Southern Medical Journal, CFebruary 19) 1957. 

Buxton, Robert W.: Treatment of the post-thrombotic leg, Maryland State Medical Journal, 

6: 139-151, 1957. 
Buxton, R. W. and Straffon, R. A.: Deep vein ligation in the post-phlebitic extremity, Surgery, 

41:471-477,1957. 
Buxton, R. W. and Straffon, R. A.: Progress in Surgery— 1956, Americana Annual, 757-759, 

1957. 
Packard, A. G., Jr.: The enzymatic debridement of wounds, The American Surgeon, 22:543-548, 

1956. 
Pessagno, D. J.: Cystic disease of the breast, American Surgeon, 23: 65-72, 1957. 
OsTER, R. H.; SmPLEY, E. R.; Pollack, B. R.; Proutt, L. M.: Experiments in Physiology, 

second revision, Maran Typographers and Printers, Baltimore, 1957. 
Shipley, E. R.: The problem of the intestines, Bull. Sch. of Med., Univ. of Md., 41:115, 

(October) 1956. 
Williamson, R. J., Hayes, M. A. and Heindenreich, W. P.: Endocrine mechanisms involved 

in water and sodium metabolism during operation and convalescence, Surgery: 41: 353-386, 

1957. 

OPERATIONS 

GENERAL SURGERY 

Thorax: 

Private Clinical 

Thoracotomy for trauma 1 

Repair diaphragmatic hernia 2 1 

Other 5 6 



DEPARTMENT OF SURGERY 



173 



OPERATIONS 
GENERAL SURGERY (Continued) 

Private Clinical 
Breast: 

Biopsy or excision of lesion 100 79 

I & E) abscess 25 

Simple Mastectomy 5 2 

Simple Mastectomy with axillary node dissection 10 

Radical Mastectomy 20 15 

135 121 
Stoniacii and DiiodeiiU)u: 

Gastrectomy— total 1 

Gastrectomy— partial 22 25 

Gastrectomy— partial with \agotomy 5 5 

Biopsy of stomach 1 

Rammstedt procedure 3 4 

Local excision of lesion of the stomach 1 

Gastrostomy 3 5 

Gastrotomy 6 3 

Gastrorrhaphy 1 1 

Closure of perforation of duodenal ulcer 5 14 

Vagotomy (alone) (postgastroenterostomy) 2 

Gastroenterostomy 3 10 

Gastroenterostomy with vagotomy 1 

Jejunostomv 1 1 

Resection of marginal ulcer 1 

Others 

l4 ^ 
Stomach and Esophagus: 

Esophagogastrcctomy 1 

Esophagectomy 1 

Excision of diycrticulum 

Closure of perforation of esophagus 

Others 1 

Spleen: 

Splenectomy for hypersplenism 3 3 

Splenectomy for rupture of spleen 3 

Others 4 1 

~^ ~1 
GaUhladder: 

Cholecystectomy (only) 75 59 

Cholecystectomy and choledochotomy 36 8 



174 BULLETIN OF THE SCHOOL OF MEDICIJSIE, U. OF MD. 

OPERATIONS 
GENERAL SURGERY (Continued) 

Private Clinical 

Cholecystostomy 1 3 

Liver (biopsy only) 6 8 

Suturing of liver (blunt trauma) 1 2 

n? ~8o 

Secondary Biliary: 

Cholecvstcctomy 

Choledochostomy 3 

Choledochoplasty 

Choledochoduodenostomy 1 

Others .' 1 

Pajwreas: 

Biopsy (only) 2 2 

Cholecvsto- or dochoduodenostomy or enterostomy 5 1 

Splanicectomy 1 4 

Pancreaticoduodenostomy or enterostomy 

Pancreatectomy 2 

Marsupialization of, cyst of 

Sphincterotomy 1 

Excision of cyst 1 

Tl ~8 

Eetroperitoneal Ttimors: 

Biopsy of 

Excision of 1 

Small Intestine: 

Lysis of adhesions (intestinal obstruction) 11 11 

Resection for gangrene (secondary to mechanical 

obstruction 1 14 

Enteroenterostomy or enterocolostomv 7 6 

Closure of fistula (simple or enterocutaneous) 3 1 

Revision of ileostomy 

Closure of perforation 2 1 

Noble Procedure 

Intussusception 2 

Others 4 3 

28~ 38~ 



DEPARTMENT OF SURGERY 175 

OPERATIONS 
GENERAL SURGERY (Continued) 

Private Clinical 
Colon mid Rectwii: 

Abdominoperineal resection 5 8 

Colectomy, left (anterior resection) 18 8 

Colectomy, right 13 4 

Colostomy construction 13 9 

Colostomy closure 5 5 

Colostomy revision 4 6 

Colectomy, partial (wedge resection) 6 8 

Colotomy (local excision of polyps, etc.) 5 4 

Total colectomy 2 1 

Perineal resection 1 1 

Cecostomy 5 7 

Swenson Procedure 1 

Others 2 2 

^ 63 
Appendix: 

Appendectomy 133 87 

Drainage of appendiceal abscess 5 14 

138 101 
Adrenal: 

Partial excision 1 

Total excision 

"l ~0 
Ahdomiiial Wall: 

Inguinal herniorrhaphy 223 191 

Femoral herniorrhaphy 8 8 

Epigastric herniorrhaphy 4 5 

Umbilical herniorrhaphy 8 40 

Ventral herniorrhaphy 19 10 

Secondary suture of dehiscence 2 12 

Diaphragmatic herniorrhaphy (via abdominal approach) . . 2 

Others .' 18 9 

284 275 
Arw-Rectal: 

Hemorrhoidectomy 81 48 

Fissure-in-ano excision 10 4 

Fistula-in-ano excision 17 19 

Pectinotomy 4 

Anoplastv 1 2 

Polyp removal (rectal) 16 3 



176 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 



OPERATIONS 
GENERAL SURGERY (Continued) 

Private 

1 ^ D perianal abscess 9 

Biopsy of sigmoidoscopv in O.R 1 

Others ...^ ' 

139 
Skin and Siihciitatieoiis Tissue: 

Local excision lesion of skin or subcutaneous tissue 88 

W^ide excision of lesion (Melanoma, etc.) 14 

Debridement of wound 9 

Suture of laceration 10 

Secondary closure of wound 2 

Skin graft and reconstructi\ e procedure 22 

Burn dressing 2 

Skin graft 30 

Muscle biopsy 3 

Implant cobalt or radium 22 

Drainage of superficial abscess 17 

Incision and drainage of pilonidal abscess 2 

Excision of pilonidal sinus or cyst 12 

Skin biopsy 3 

Bone marrow biopsy 3 

Others 3 

242 
Lymyhatic Srstevi: 

Biopsy (not abdominal) 23 

Radical excision (except neck) 2 

Others 

"25 
Arterial System: 

Aortic resection for aortic graft 1 

Peripheral arterial graft 

Endarterectomy 4 

Ligation of artery 

Excision of A-V fistula 

S\ mpathectomy (not for hypertension) 30 

Others 4 

l9 
Venous System: 

Portacayal anastamosis 1 

Splenorenal anastomosis 1 

Ligation and stripping of saphenous yein 75 



Clinical 

30 
2 
2 

110 

49 

8 
15 
15 
11 
24 
50 
105 
12 

9 
21 

2 

8 

6 

3 

1 

339 

38 
1 

2 

"41 



1 

5 



1 
43 
13 

"63 

1 



24 



DEPARTMENT OF SURGERY 



177 



OPERATIONS 
GENERAL SURGERY (Continued) 



Private 



Ligation of saphenous vein 12 

Local excision of veins 

Thrombectomy 1 

I li resection stomach for esophageal varices 

Ligation of esophageal varices 1 

Other 

Hand and Tendons: 

Incision and drainage of space abscess 

Exploration of tendon sheaths 4 

Primary tenorrhaphy 14 

Repair of peripheral nerve 1 

Transplant of peripheral nerve 

Palmar fasciectomy 

Others 4 

"23 

Orthopaedic and Extremities: 

Amputation, mid thigh 11 

Amputation, tibial 6 

Amputation, other type, leg 3 

Amputation, toe 7 

Amputation, arm 1 

Amputation, finger 5 

Excision of ingrown toenail 6 

Hemipelvectomv 

Open and closed reduction of fracture in Operating Room 58 

Excision of Baker's Cvst 2 

Excision, ganglion of foot or wrist 7 

Osteotomv 2 

138 

Thyroid: 

Total thyroidectomy with neck dissection 

Total thyroidectomv 1 

Subtotal thvroidect()m\- 51 

Biopsy of thvroid 3 

Parathyroid adenoma 1 

Others 3 

I9 



Clinical 

4 



1 



1 

11 

3 
24 

2 

I 

3 

1 

~45 

24 
12 

5 
11 

1 

6 





2 

1 

3 



~65 

1 

3 

18 


1 

~23 



178 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 



OPERATIONS 
GENERAL SURGERY (Continued) 

hifcctio)!: 

Drainage of subphrenic abscess 

Drainage of subhepatic abscess 

Drainage of peh'ic abscess 

Drainage of intra-abdominal abscess 

Others 

Miscellaneous: 

Exploratory laparotomy with diagnosis not made 

Exploratory laparotomy, stab wound 

Exploratory laparotom\', gunshot wound 

Exploratory laparotomy with lysis of adhesions 

Head and Neck: 

Branchiogenic cyst removal 

Commando 

Radical neck dissection 

Mandible resection, partial 

Excision of cervical mass (Tumor mass) 

Excision lesion of accessory sinus 

Excision lesion of gingiva 

Excision lesion of mouth or lip 

Biopsy 

Excision lesion of nose 

Excision lesion of palate 

Excision lesion of parotid gland 

Excision lesion of submaxillary gland 

Hemiglossectomy or excision lesion of tongue 

Laryngectomy total 

Laryngectomy partial 

Laryngoscopy (biopsy) 

Biopsy larynx 

Excision of th^'roglossal cyst 

Closure of pharynstoma 

Others 



Private 



29 



Clinical 



1 


4 


1 





2 


2 


3 


3 


2 


3 



12 



5 


4 





15 


1 


4 


23 


18 



41 



2 











1 


5 


1 


1 


4 


2 


1 





1 





2 


2 





1 


1 








1 


5 


3 


3 


1 


2 


2 


1 





1 


1 











1 


2 


1 








6 


22 



33 



43 



DEPARTMENT OF SURGERY 



179 



OPERATIVE DEATHS-GENERAL SURGERY 

CLINICAL SERVICE 



Emergency: 2 



Hosp. No. Initial Primary Diagnosis 



Operation 



Cause of Death Autopsy 



101-3-93 J.S. Ruptured spleen Splenectomy 

Multiple fractures 
(ribs, rt. arm) 

134-2-66 G.W. Blunt trauma with Repair, extensive 
intra-abdominal lacteration, liver 
injury Close thoracotomy 

Cranio-cerebral 
trauma 

Hemothorax 



Acute renal failure Med. 
Exam. 

Possible cerebral Med. 
edema Exam. 



Gastrointestinal: 


11 








101-9-26 


L.S. 


Perforated 

duodenal ulcer 


Closure of 
perforation 


Peritonitis 


No 


013-1-69 


B.D. 


Biliary cirrhosis 


Common duct 










Cholangitis 


exploration 
Liver biopsy 


Acute renal 
failure 


Yes 


042-9-58 


J.T. 


Cholecystitis 


Liver biopsy 


Hepatic failure 


Yes 


080-7-24 


D.B. 


Chronic ulcerative 
colitis 


Colectomy 


Peritonitis 
septicemia 


Yes 


098-9-27 


G.B. 


Strangulation 
Obstruction, ileum 


Resection of ileum 


Peritonitis 


No 


134-9-64 


A.D. 


Small bowel 
obstruction 


Resection of 
jejunum 


Peritonitis 


Yes 


051-8-96 


F.K. 


Appendicitis with 
perforation 


Appendectomy 


Generalized 
peritonitis 


Yes 


134-2-64 


E.R. 


Acute appendicitis 


Appendectomy 


Unknown 


No 










Possible perforation 










sub diaphragmatic 










abscess 












Shock 




135-0-93 


E.W. 


Pancreatic cyst 


Resection of 
pancreatic cvst 


Inanition 


No 


135-5-86 


A.V.D 


Perforated 


Closure perforated 


Cardiac failure 


No 



180 



/U/1 LET/N or THE SCHOOL OF MEDICINE, U. OF MD. 



OPER/\TIVE DEATHS-GENERAL SURGERY 

CLINICAL SERVICE 



Hosp. No. Initial Primary Diagnosis 



Operation 



Cause of Death Autopsy 



082-9-00 W.V. 



Cancer: 8 
007-3-83 A.R. 



103-8-04 W.S. 



017-7-12 M.B. 



Large bowel 

ohstriictioii 



106-6-21 B.J. 

108-8-65 D.C. 

134-2-77 M.B. 

041-9-17 E.J. 

134-3-84 J.LcD. 

Cardiovascular: 2 

109-9-24 R.N. 



Carcinoniii of the 

stomach 
Bullous 

em|ih\scnia 

Carcinoma ol the 
Stomach 
(Ohstructive) 

Intestinal ohstriic- 
tion due to recur- 
rent carcinoma 
(Carcinoma of 
cecum) 

Carcinoma of the 

larynx 
Esophageal 

obstruction 

Carcinoma of the 
hepatic flexure 

Carcinoma of the 
descending; colon 



Cecostomy 
lleo-transverse 

colostomy 
Closure cecostomy 

Subtotal gastric 

resection 
Splenectomy 



Cerebral vascular Yes 

accident 



LInknovvn 

Possible spontane- No 
ous hemothorax 



CiastrocnterostomN' Carcinomatosis Yes 



Resection of the 

small bowel 
lleo-ileostomy 



Gastrostomy 

Cecostomy 
Paliatiye resection 



Carcinomatosis 



P<M- 



Carcinoma of the Gastrojejunostomy 
stomach 

Carcinomatosis Exploratory 

(Primary site laparotomy 

undetermined) Liver biopsy 



Arteriosclerotic 

peripheral 

vascular disease 
Gangrene, right 

foot 



Mid thigh 

amputation 



eritonitis 
Wound dehiscence 
Shock 



Peritonitis Yes 



Coronary No 

thrombosis 

LInknovvn No 

Probable massive 
atelectasis 

Carcinomatosis Yes 

Carcinomatosis No 



Consestix'e failure No 



DEPARTMENT OF SURGERY 



181 



OPERATIVE DEATHS-GENERAL SURGERY 

CLINICAL SERVICE 



Hosp. No. Initial Primary Diagnosis 



Operation 



Cause of Death Autopsy 



109-1-72 M.L. 



Miscellaneotts: 1 
095-0-49 L.W. 



Arteriosclerotic Supracondylar 

peripheral amputation 

vascular disease 

Gangrene, left foot 



Probable Med. 

myocardial Exam, 

infarction 



Non-toxic nodular Subtotal Coronary occlusion Yes 

goiter tb\roidectomv Pulmonary 

embolus 



PRIVATE SERVICE 



Emergency: 2 










106-7-28 D.K. 


Traumatic sever- 


Ligation, femoral 


Crush syndrome 


Yes 




ance of the 
femoral artery, 


vein 


with acute renal 
failure 






femoral vein and 










sciatic nerve 
Massi\'e soft tissue 










injury 








084-3-36 C.W. 


Blunt trauma 
Perforation of the 
jejunum 


Closure of 
perforation 


Peritonitis 


Med. 
Exam. 


Gastro'nitesthial: 


4 








108-2-42 C.B. 


Pancreatitis with 
jaundice 


Exploratory 

laparotomy 
Choledocotomy 
Sphincterotomv 


Uremia 


Yes 



101-7-15 M.W. 
107-0-99 M.H. 

050-1-35 I.D. 



G. I. hemorrhage Exploratory 
laparotomy 

Diverticulitis with Resection fistula 

perforation 
Chronic vesico 



vaginal fistula 

Chronic 

cholecystitis 



Repair of 
cecostomy 

CholccN stectomv 



Shock Yes 

Recurrence of No 

fistula 
Malnutrition 
LIrcmia 

Unknown proba- No 
ble cerebral 
embolus 



Js2 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF AID. 



OPERATIVE DEATHS-GENERAL SURGERY 

PRIVATE SERVICE 



Cancer: 5 



Hosp. No. Initial Primary Diagnosis 



Operation 



Cause of Oeath Autopsy 



101-7-38 E.K. Carcinoma of the Cecostomy Shock No 

transverse colon 
(Obstructed) 

099-9-97 C.B. Carcinoma of the Esophago- Mediastinitis Yes 

esophagus gastrectomy 

107-4-72 AI.C. Leiomyosarcoma of Obstructive Peritonitis Yes 

the jejunum resection 

(Perforated) 

018-7-41 E.P. Adenocarcinoma of Anterior resection Acute pancreatitis Yes 

the rectum Lobar pneumonia 



099-5-11 VV.M. 



Cardiovascular: 1 
098-946 F.B. 



Miscellaneous: 1 
009-6-54 A.B. 



Carcinoma of the Cecostomv 

sigmoid colon Sigmoid resection 
with obstruction Closure of 
cecostomv 



Abdominal aortic Endo-aneurys- 
aneur\'sm morrhaphy 

ruptured into 



LIremia 



Yes 



duodenum 



Subphrenic 
abscess, left 



Incision and 
drainage 



Shock 



No 



Retro- peritoneal Yes 

hematoma 
Pancreatitis 
Shock 



NONOPERATIVE DEATHS 

CLINICAL SERVICE 

General Surgery: 17 

101-7-25 H.G. Cachexia secondar\^ to 

metastatic carcinoma of 
the prostate 

100-5-63 W.H. Suspected choangioma 
065-9-25 B.W. Carcinomatosis ^adeno 

carcinoma of the ovarv) 



Shock 

Primary diagnosis 
Primars' diagnosis 



No 

No 
No 



DEPARTMENT OF SURGERY 



183 



NONOPERATIVE DEATHS 

CLINICAL SERVICE 



Hosp. No. Initial 



Primary Diagnosis 



Cause of Death 



Autopsy 



106-1-46 


L.VV. 


083-9-96 


J.G. 


097-0-68 


G.P. 


107-7-48 


J.T. 


100-7-41 


L.B. 


107-1-77 


A.J. 


020-2-47 


G.J. 


134-5-97 


H.L. 


109-7-39 


T.McG. 


failure 




000-8-47 


C.S. 



109-8-62 X.R. 



109-5-58 W.S. 



108-7-18 
109-6-55 



I.e. 
c.c. 



Second and third degree 
burns. 80% body surface 

Carcinoma of the maxillary 
antrum 

Inflammatory carcinoma of 
the breast 

Second and third degree 
burns, 50/? body surface 

Carcinoma of the rectum 

Possible carcinoma of the 
colon 

Perforated duodenal ulcer 

60% burns, second and third 
degree 

70% burns, second and third 
degree 

Fractured mandible 
Chronic Osteomyelitis 

Arteriosclerotic peripheral 
\ascular disease with 
gangrene, lower extremities 
bilaterally 

Second and third degree 
burns, 45% body surface 

Perforated duodenal ulcer 

Acute hemorrhagic pancreatitis 



Shock 




No 


Carcinomatosis 




No 


Carcinomatosis 




No 


Septecemia 




Yes 


Carcinomatosis 




Yes 


Carcinomatosis 
Myocardial infa 


rction 


No 


Coronary artery 


occlusion 


Yes 


Probable septicemia 


Med. 
Exam, 


Probable septicemia 


Med. 
Exam, 



Malnutrition 

Shock 

Hemorrhage 

Cardiac failure 



No 



Yes 



Acute renal failure 


Med 




Exam, 


Peritonitis 


Yes 


Cardiac arrest 


Yes 



PRIVATE SERVICE 



General Surgery: 16 



100-0-49 


J.M. 


1 hrombophlebitis 


Probable pulmonary 
embolus 


No 


106-3-41 


IIAV. 


Laennec's cirrhosis 


Hepatic failure 


Yes 


101-3-69 


J.A. 


Carcinoma of the breast 


Carcinomatosis 

(Cerebral metastasis) 


No 



184 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 



NONOPERATIVE DEATHS 







PRIVATE SERVICE 




Hosp. No. 


Initial 


Primary Diagnosis 


Cause of Death 


Autopsy 


080-4-08 


G.B. 


Carcinoma of the rectum 


Pulmonary embolism 


Yes 


101-3-72 


S.S. 


Carcinoma of the stomach, 
perforated 


Peritonitis 


Yes 


056-5-32 


H.S. 


Carcinoma of the ovary 


Carcinomatosis 


No 


070-4-03 


V.P. 


Carcinoma of the left breast 


Carcinomatosis 


No 


107-9-04 


J.C. 


Carcinoma of the stomach 


Carcinomatosis 


Yes 


108-2-35 


G.M. 


Carcinoma of the pancreas 


Carcinomatosis 


No 


075-9-48 


N.S. 


Ulcerati\'e colitis 


Uremia 

Malnutrition 


No 


108-0-12 


E.S. 


Chronic encephahtis 


Cerebral edema 
Primary diagnosis 


Yes 


107-2-63 


M.G. 


Carcinoma of the breast 


Carcinomatosis 


No 


107-7-91 


F.E. 


Intertrochanteric fracture, 
right femur 


Probable cerebro 
vascular accident 


No 


053-4-58 


L.G. 


Fibrosarcoma, latissimus 
dorsi, recurrent 


Primary diagnosis 


No 


134-1-98 


I.D. 


Chronic pj'elonephritis 


Uremia 


Yes 


072-2-23 


W.W. 


Lannaec's cirrhosis 


Bleeding esophageal 
varices and hepatic 
failure 


Yes 



OPERATIVE PROCEDURES PERFORMED AT THE MARYLAND STATE 

PENITENTIARY BY THE UNIVERSITY OF MARYLAND SURGICAL 

RESIDENTS DURING APRIL AND MAY, 1957 



Date 


Patient 


Operation 


4-4-57 


C.C. 


Appendectomy and cholecystectomy 


4-4-57 


RJ. 


Right inguinal herniorrhaphy 


4-4-57 


J.V^. 


Left inguinal heriniorrhaphy 


4-8-57 


W.P. 


Cholecystectomy 


4-10-57 


B.S. 


Right inguinal herniorrhaphy 


4-10-57 


A.H. 


Hemorrhoidectomy 


4-11-57 


C.T. 


Bilateral herniorrhaphv 


4-15-57 


B.P. 


Extraction of knife blade in shoulder 


4-15-57 


R.B. 


Excision of fistula in ano 


4-17-57 


S.L. 


Exploratory laparotomy 



DEPARTMENT OF SURGERY 185 

OPERATIVE PROCEDURES PERFORMED AT THE MARYLAND STATE 

PENITENTIARY BY THE UNIVERSITY OF MARYLAND SURGICAL 

RESIDENTS DURING APRIL AND MAY, 1957 

Date Patient Operation 

Bilateral ligation varicose veins with stripping 

Hemorrhoidectomy 

Hemorrhoidectomy 

Excision tumor left axilla 

Left inguinal herniorrhaphy 

Bilateral herniorrhaphy 

Excision hydrocele 

Left inguinal herniorrhaphy 

Excision of fistula in ano 

Excision ganglion right wrist 

Hemorrhoidectomy 

Excision fatty tumor, middle finger right hand 

Excision accessory parotid gland 

Right inguinal herniorrhaphy 

Excision pilonidal cyst 

Excision left medial miniscus 

Hemorrhoidectomy 

Peri-rectal abscess— incision and drainage 

Gangrenous small bowel due to adhesions— 

Resection of 2V2' jejunum 
Right inguinal herniorrhaphy 
Bilateral herniorrhaphy 
Excision thyroglossal cyst and duct 
Palmar fasciectomv for dupuytrens 
Hemorrhoidectomy 
Hemorrhoidectomy 
Hemorrhoidectomy 
Excision of fistula in ano 
Excision exostosis pubic bone 
Cholecystectomy and appendectomy 
Excision of undescended testi 
Bilateral ligation and stripping of \aricose \eins 
Excision of fistula in ano 
Plastic repair of lip 
Excision of parotid duct stone 
Hemorrhoidectomy 
I & D periurethral abscess 
HemorrhoidectomN' 
Subtotal gastric resection 
Hemorrhoidectomx' 



4-17-57 


J.K. 


4-23-57 


CJ. 


4-24-57 


L.A. 


4-24-57 


G.W. 


4-25-57 


D.T. 


4-25-57 


W.E. 


4-25-57 


E.B. 


4-29-57 


N.W. 


4-29-57 


L.F. 


5-1-57 


A.P. 


5-1-57 


J.P. 


5-1-57 


M.McC. 


5-1-57 


W.H. 


5-2-57 


C.V. 


5-2-57 


V.W. 


5-6-57 


E.R. 


5-9-57 


JJ. 


5-9-57 


H.D. 


5-13-57 


B.H. 


5-15-57 


R.L. 


5-15-57 


D.D. 


5-15-57 


C.H. 


5-16-57 


J.S. 


5-16-57 


R.E. 


5-20-57 


C.C. 


5-20-57 


D.B. 


5-20-57 


H.B. 


5-20-57 


J.B. 


5-22-57 


R.M. 


5-22-57 


W.Q 


5-23-57 


R.L. 


5-23-57 


E.W. 


5-23-57 


W.C. 


5-23-57 


E.D. 


5-27-57 


P.C. 


5-27-57 


J.K. 


5-27-57 


G.W. 


5-29-57 


A.S. 


5-29-57 


F.J. 



186 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

ORTHOPEDIC SURGERY 

This division of surgery is under the guidance of Dr. Allen V^oshell. At the time 
of this w riting it is the least satisfactory of the surgical divisions from the viewpoint of 
a discipline for teaching house officers and students the rudiments of clinical orthopedic 
surgerv. The background of this (or any other orthopedic) di\ision may offer some 
insight into its manv difficulties. For many years, and to the present time, the treatment 
of acute fractures, a modicum of reconstructive surgery, as well as much of the surgical 
therapy of soft tissue lesions in the vicinity of ligaments and joints has been considered 
the province, not onlv of the orthopedic surgeon, but of the general surgeon. The 
clea\age of orthopedic surgerv from general surgery, while onl\- moderately recent, 
has never been acute, abrupt or complete. For this reason the specialty has suffered 
much and frequentlv from "pirating" at the hands of the general surgeon and as a 
consequence a stern effort to build up an active and aggressive orthopedic division 
has been dissipated through lack of support and insistence. 

This specialty suffers from another handicap. The healing of bones is a long and 
slow process and the often required plaster of Paris supports for these healing structures 
commonly necessitates prolonged bed rest and tedious, almost interminable nursing 
care. Thereby a hospital bed occupancy may and commonly is reckoned in terms of 
months and not of davs or weeks. 

These two observations alone supply a large insight into the outstanding need of 
this division— beds, for both private and ward patients. 

Orthopedic surgeons have for a goodly number of years been largely concerned 
with the physical measures of rehabilitation of patients. The need for emphasis upon 
this late aspect of bony and soft tissue injury is nowhere more urgent or more deeply 
appreciated than in this field. For the most part the means at the disposal of orthopedists 
for emphasis upon this aspect of disease have been minimal and grudging. In recent 
years a new and aggressive group of physician specialists in physical medicine and 
rehabilitation has sprung up and taken command of this field. The result has been an 
outpouring of money, space and technical assistance far in excess of that ever gained 
or hoped for by the orthopedist. He is properly disgruntled. On the other hand it is 
to be acknowledged that additional knowledge, more elaborate techniques, impro\ed 
care and an increased salvage rate of patients can be pointed to with some pride bv the 
physical therapist. 

It is foreseen that the Department of Physical Medicine and Rehabilitation will be 
largely supplied with personnel, apparatus, and equipment which will augment most 
effecti\ely the work in the Division of Orthopedic Surgery. In this way a second great 
need in this division will be supplied. 

Until the past fiscal year, this division has been without a resident house staff for 
se\eral years. During this hiatus accreditation for training in this specialty' has been on 
qualified and on a year-to-year basis. This, combined with the paucity of clinical 
material has made the procurement of residents difficult and precarious. 

The best solution of these difficulties at this moment is being planned for the 
coming year. The program of teaching and training as envisioned now will be set at 
one and one-half years of training in adult orthopedic surgerv and fractures at the 



DEPARTMENT OF SURGERY 187 

University Hospital; one vear of orthopedic surgery in children at Keman's Hospital 
tor Crippled Children and a six months "\isiting service" at the Rosewood Training 
School in Ouings Mills, Marvland, and at the Montebello State Hospital, for training 
in treatment and rehabilitation of patients with cerebral palsy and chronic disease. This 
rather comprehensive program combined with a planned instructional period, probably 
in anatomy (possibly, upon demand, in the research laboratory) should be both 
attractive and afford a more than satisfactory training in clinical orthopedic surgery- 
Teaching of medical students in this division encompasses both the junior and 
senior years. A series of didactic lectures is gi\ en in the second semester of the junior 
vear plus instruction in orthopedic diagnosis and examinations in the out-patient clinic 
during one-third of the surgical quarter. Onlv a small fraction of senior students have 
a clinical service in orthopedic surgerv. One-fourth of this class is assigned to this 
division for one month of instruction. During this period, ward rounds and bedside 
discussions are scheduled and carried on at the Universitv and Kernan's Hospital for 
Crippled Children as one part of the senior students experience. 

A program of research, either at a basic level or one devoted to clinical problems, 
is non-existent in this division. This is recognized and deprecated by its members, all 
of whom serve in a part-time capacit)". The lack of a well supported group of junior 
associates and men in training has not made possible a solution of this defect. It reflects, 
in some degree, an almost universal trend among orthopedic surgeons today (A recent 
American College of Surgeons publication. Surgical Forum, 1956, records 9 papers on 
orthopedic research projects from se\en medical schools. This represents less than 5 
percent of the reported papers.). 

During the preceding vear this division has been supplied handsomelv bv the 
Women's Board of the University Hospital with funds for the purchase of operation 
room and fracture equipment. 

!(■ !<■ H- 

Resident Staff: Resident— Dr. Xick A. \'alis 

Publication: 

\'osHELL, A. F.: Anatomy of the knee joint, American Acad-mv ot Orthopedic Surgeons, Instruc- 
tional Course Lecture. VIII, 1956. 



188 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

ORTHOPEDIC SURGERY 

Private Clinic 

Abscess. I &D 2 4 

Achilles tendon lengthening 

Amputation, rcxision 

/Xrthorociesis 10 9 

Arthroplasty 1 1 

Arthrotomy 6 1 

Baker's cvst, excision 1 1 

Biopsy 5 

Bone cyst, excision or curettage 2 

Bone graft 4 1 

Bone tumor, excision 3 3 

Bunionectomy 6 2 

Capsulotomy 1 

Cast, body 4 10 

leg . ' 5 9 

miscellaneous 6 4 

Closed reduction, fracture and dislocations 45 57 

Crutchfield tongs 1 

Excision, bursa 1 2 

exostosis 3 

synoyia 

Exploration, tendon sheath 

Extraction of nail or plate 2 

Fasciotomy 

I lip prosthesis 1 1 

Insertion of nail pin 4 16 

Laminectomy 8 

Laminectomy with fusion 4 2 

Miniscusectomy 5 

Miscellaneous (includes manipulation) 3 2 

Muscle transplant 

Neurolysis (diyision) 1 

Open reduction, fractures and dislocations 30 60 

Ostectromy, partial (sequestrectomy) 1 4 

Ostectomy 6 1 

Patellectomy 1 1 

Suteroperation 

Saucerization 1 5 

Osteotomy 3 

162 210 



DEPARTMENT OF SURGERY 



189 



OPERATIVE DEATHS-SURGICAL SPECIALTIES 

CLINICAL SERVICE 

Orthopedic Stirgery: 7 



Hosp. No. 


Initial 


Primary Diagnosis 


Operation 


Cause of Death 


Autopsy 


009-7-16 


J.L. 


Intertrochanteric 
fracture, left 
femur 


Open reduction 


Cerebral vascular 

accident 


No 


100-4-94 


E.S. 


Fracture surgical 
neck, left femur 


Open reduction 


Broncho- 
pneumonia 


No 


099-9-58 


A.F. 


Fracture surgical 
neck, right 
femur 


Open reduction 


Probable cerebral 
accident 


No 


106-2-59 


C.S. 


Intertrochanteric 
fracture, right 
femur 


Open reduction 


Probable 
pulmonary 
embolus 


No 


134-5-04 


H.M. 


Intertrochanteric 
fracture, right 
femur 


Open reduction 


Probable coronary 
thrombosis 


No 


134-2-48 


W.N. 


Intertrochanteric 


Open reduction 


Probable cerebral 


No 






fracture, left 
femur 




vascular accident 


109-2-61 


s.w. 


Intertrochanteric 
fracture, right 
femur 


Open reduction 


Pulmonary 
embolus 


Med. 
Exam. 



Ortlwpedic Surgery: 1 



NONOPERATIVE DEATHS 

CLINICAL SERVICE 



Hosp. No. Initial 



Primary Diagnosis 



Cause of Death 



Autopsy 



100-2-76 C.T. 



Intertrochanteric 

fracture, right femur 



Probable cerebral vascular No 
accident 



UROLOGY 

The Dix'ision of Uroiogx' is under ihc direction ot Dr. John D. ^Oiiiig, jr. During 
the past year the training of house officers and the teaching of medical students was 
done solelv at Unixersitv Hospital. Approximately six ward patient beds are assigned 
to the resident staff of this division and it is from these beds that the essential bedside 
teaching and training is done. This di\'ision maintains an acti\'e out-patient service 
which, earlier in the year, met patients four half-davs weeklv and more recently is 
seeing patients each week day. A very actixe cystoscopic unit is maintained in the 



190 BULLETIN OF THE SCHOOL OF MEDICINE. IJ. OF AID. 

hospital and cxtensix e knowledge and experience is made possible through the recent 
reno\ation of this latter unit. 

This di\ision is seriously handicapped by a shortage of patient beds. Few urologic 
patients are long-term patients; and, therefore, the division has suffered less because of 
this defect than ha\e others. Because of the excellent functioning of the cystoscopic 
unit it has been possible to undertake certain operative procedures here— transurethral 
prostatectomies— although this location is distinctly less desirable than the main opera- 
tion room area. This situation, though undesirable, has been abetted by the ease 
and expedition with which these operations can be scheduled and handled by a well- 
trained nursing staff, quite in contrast to the situation at present existing in the 
operation room suite. 

Not only is this division handicapped seriously by its lack of ward service beds, but 
also by its lack of operation room space. No good solution for this situation is im- 
mediatelv axailable, although it is apparent that the soon to be undertaken enlargement 
of the operation room floor will solve one of the present difficulties under which this 
di\ision works. A second hoped-for solution was allocation of ward bed space on the 4B 
hospital wing, now the site of a surgical compensation ward. To date it has not been 
possible to realize this hope. 

The lack of in-patient beds has been felt in another wav by this service— there has 
been some limitation in the undertaking of prolonged diagnostic or observation pro- 
cedures on an in-patient basis. A strenuous eff^ort is now being brought to fruition, 
whereby resident house oftlcers mav attain a portion of their training at the Fort 
Howard Veterans Hospital on a rotational basis. This will augment considerably the 
clinical experience and training of these men. The urologic program at the Veterans 
Hospital is under the supervision of Dr. Flerman J. Meisel. 

A further expansion in clinical experience is being undertaken in the coming year 
at the Montcbello State Hospital in Baltimore. This facility has a large number of 
chronicallv ill patients under intense rehabilitational training. Many of these indi- 
\'iduals have serious neurologic damage afl:ecting their urinary tract, and considerable 
knowledge and training can be gained and furnished the young urologic surgeon in 
the diagnosis of these deficits and the experience essential in the proper care of such 
patients. A most helpful and svmpathetic attitude has been displaved bv the physicians 
at the Montebello Hospital in supporting this program and in equipping a unit suitable 
for this undertaking. 

Extension of teaching and training areas into other institutions has been a means 
utilized at this moment for making this ser\'ice a creditable one. It is to be recognized 
that it is a solution less desirable than one which admits teaching and training under 
a more closely integrated, more nearU' uniform and more closelv superxised Llnixersitx 
service and must be considered for the moment as, in some degree, temporary and 
subject to the modifications and inherent demands of the non-parent institution. 

The teaching of medical school students is an essential function of the urologic 
division. Experience in the junior year is gained in the out-patient area and is devoted 
to diagnosis or urologic disease, instrumentation and treatment carried out upon an 
ambulatory basis. This is a most valuable experience and the realization of this has 



DEPARTMENT Of SURGERY 191 

brought ahout some improvement in teaehing in this sphere. Further improvement and 
refinements in teaching techniques are under consideration. 

The senior medical students have a hmited exposure to this division. It has been 
possible to assign one-fourth of the surgical section to urology for a period of one month. 
During this time students have participated in clinical and roentgenologic conferences 
and have had some introduction to diagnostic instrumentation procedures. 

Research Fitiids x- >f x- 

This division was the recipient of a gift of $5,000 from the estate of Mr. Augustus 
Lotze of Glen Burnie, Maryland. 

Research Projects x. >i. x. 

This division is engaged currently in differential renal studies with the use of 

radioactive diodrast clearance measurements as recorded by the use of scintillation 

counters. This study is being undertaken in conjunction with members of the Division 

of Radioactive Isotopes. 

>t- X- X 

Resident Staff: Resident— Dr. C. E. Simons, Jr. 

Assistant Residents— Dr. Marcelo Lima and Dr. James R. Powder 

LECTURES AND COMMUNITY SERVICES 

(1) "Management of Urinary Calculi" 

Panel Discussion at Baltimore City Medical Society- October 5, 1956 
Dr. W. W. Scott 
Dr. T. B. Connor 
Dr. J. D. Young, Jr. 

(2) "Renal Function after Prolonged Ureteral Obstruction" 

Mexican Urological Association Meeting, Vista Hermosa, Mexico- 
November 2, 1956 
Dr. J. D. Young, Jr. 
Dr. Leopoldo Gomez Reguera 

(3) "Hypertension and Renal Vascular Disease" 

Presented at Central Ohio Urological Society— November 20, 1956 
Dr. J. D. Young, Jr. 

(4) "Cancer of the Genito-Urinary Tract" 

Written for the Baltimore Chapter of the American Cancer Society for Lay 

Publication 
Dr. J. D. Young, Jr. 

(5) "Prostatectomy in a Hemophiliac" 

Mid-Adantic Section of the American Urological Association, Virginia Beach, 

Virginia-March 20-23, 1957 
Dr. J. D. Young, Jr. and 
Dr. M. S. Sacks 

(6) "Obstructive Uropathies" 

Wicomico County Medical Society— May 13, 1957 
Dr. J. D. Young, jr. 



192 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 



UROLOGY 

Private 
Urethra: 

Llrethral dilations (Male and Female) 596 

Lliethrotomv 6 

1 & D urethral abscess 1 

Excision urethral dixerticulum 

603 
Female Urethral and External Genitalia: 

Salpingogram 38 

Proctoscopy 41 

79 
Penis: 

1st stage hypospadius ' 4 

2nd stage hypospadius 5 

Meatotomy 25 

Circumcision 24 

Biopsy 5 

I & D Abscess 2 

Amputation of phallus 1 

Phallectomv 2 

68 
Scrotitm and Contents: 

Amputation scrotum 

Vasectomy 34 

Biopsy testes 6 

I & D abscess 3 

I & D tumor 3 

46 
Ureter: 

Ureterocvstotomy 

Ureterolithotomy 16 

Uretero-neocystoscopy 1 

Cystoscopy with manipulation urethral stone 6 

Ureteroplasty 1 

24 
Bladder: 

Cystectomy 6 

Cystotomy 15 

CystoscopN' 578 

Litholapaxy 40 

T U R or fulguration tmnor 60 

T U R Biopsy lesion 53 

C\ stoscop\' and retrogrades 406 



Clinical 

118 



4 

3 
125 

26 
30 
56 

3 

2 

12 

107 

4 

1 

2 


131 

1 
1 
5 
4 

II 


4 

2 

~6 

1 

7 
495 

17 

16 

69 
269 



DEPARTMENT OF SURGERY 



193 



UROLOGY 

(Continued) 

Private Clinical 

Cystoscopy and endoscopy 59 50 

Repair ruptured bladder 1 

Total cystectomy— isolated ureteroileostomy 1 

Segmental resection of bladder 1 

"T2I9 925 

Prostate: 

T U R, prostate 108 78 

Prostatectomy, retropubic, simple 21 18 

Prostatectomy, retropubic, radical 1 

Prostatectomy, suprapubic, simple 10 1 

Prostatectomy, surprapubic, radical 10 1 

Prostatectomy, perineal, simple 

Prostatectomy, perineal, radical 6 5 

156 l03 

Kidney: 

Nephrectomy 12 10 

Biopsy 3 1 

Nephrostomy 8 2 

Exploration kidney— removal renal cyst 3 3 

Removal cystic kidney 1 

Partial nephrectomy— repair of ruptured kidney 1 

Excision kidney cyst 8 

Nephropexy 1 

Pyelithotomy 2 4 

Pyeloplasty 1 

Nephro-ureterectomy 1 

Biopsy 3 3 

Orchiopexy 6 1 

Orchiectomy 15 12 

65 "36 
Seminal Vesicles: 

Repair vaginal \ csicular fistula 3 3 

Vesical lithotoni) 1 

Seminal Acsiculectomy 2 

"6 "3 

Spermatic Cord: 

Hydrocelectomv 17 8 

Epididymis: 

Epididvmectomy 1 1 

Epidid\'mo-orchiectom\' 3 

~4 ^1 



194 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF AID. 



UROLOGY 

(Concluded) 

Miscellaiieoiis: 

Aortogram 

Differential renal function studies 

Seminal \esiculogram 

Air insufflation 

Biopsy of cervical lymph node 

Ventricular urethral shunt 

Resection of distal portion of ureter with anastomosis 

of bladder 

I & D perineal abscess 

Exploration lap. biopsy rt. iliac Ivmph node 

Multiple disection vesicular urethroplasty 

Foley 

I & D surprapubic abscess 

Hemenephrectomy 

Adrenalectomy 

Diyerticulectomy 

Hernioplastv 



Private 



Clinical 



10 


7 


15 


31 


4 





9 


6 





1 





2 





1 


10 


7 





1 





1 





1 


3 





2 





2 


1 


4 





6 


4 



65 



63 



OPERATIVE DEATHS-SURGICAL SPECIALTIES 

CLINICAL SERVICE 

Urology Service: 5 



Hosp. No. Initial Primary Diagnosis 



Operation 



Cause of Death Autopsy 



101-7-82 J.L. 

136-0-35 G.H. 

135-0-14 C.S. 

102-3-10 G.G. 

108-3-56 M.H. 



LTrethral stricture 
Perforation urethra 
with extra\'asa- 
tion and abscess 

Clear cell 
carcinoma, 
left kidney 

Carcinoma of 
urinary bladder 

Benign prostatic 
h^•pertrophy 

Carcinoma of 
urinary bladder 



Excision and 

drainage 
LIrethral dilatation 

Nephrectomy 



Fulguration of 
bladder tumor 

Trans urethral 
resection 

Cystectomy and 
construction of 
ileal bladder 



Possible acute No 

gastric dilatation 
with aspiration 
asphyxia 

Bilateral No 

pulmonary 
metastasis and 
cor pulmonale 

LIremia Yes 



Probable cerebral No 
vascular accident 

LIremia No 

Cardiac failure 



DEPARTMENT OF SURGERY 



195 



OPERATIVE DEATHS-SURGICAL SPECIALTIES 

PRIVATE SERVICE 



Urology: 3 



Hosp. No. Initial Primary Diagnosis 



Operation 



Cause of Death Autopsy 



100-3-51 R.S. 

100-9-06 A.S. 
107-9-29 P.T. 



Sarcoma of the 
prostate with 
extension to 
urinary bladder 

Benign prostatic 
hypertrophy 

Carcinoma of the 
bladder 



Cystotomy and 
biopsy 



T. U. R. 

Left nephrostomy 
Biopsy of bladder 



Hemorrhage, No 

urinary bladder 



Myocardial Yes 

infarction 

Probable No 

pulmonary 
embolus 



Urology: 4 



NONOPERATIVE DEATHS 

CLINICAL SERVICE 



Hosp. No. 


Initial 


Primary Diagnosis 


Cause of Death 


Autopsy 


101-8-59 


L.A. 


Carcinoma of the urinary 
bladder 


Carcinomatosis 


Yes 


108-5-35 


E.G. 


Carcinoma of the left kidney 


LIremia and primary 
diagnosis 


Yes 


091-5-83 


L.M. 


Chronic pylonephritis 
Hydronephrosis 
Bladder neck obstruction 


LIremia 


No 


134-9-28 


H.G. 


Carcinoma of the prostate 
with metastasis 


Bilateral broncho- 
pneumonia 
Hemorrhage from the 

o 

bladder 


Yes 



Urology: 3 



NONOPERATIVE DEATHS 

PRIVATE SERVICE 



Hosp. No. Initial 



Primary Diagnosis 



Cause of Death 



101-7-15 G.S. Benign prostatic hypertrophy Cardiac failure 

Corpulmonale 

080-2-85 M.A. Carcinoma of the bladder Carcinomatosis 

081-6-02 S.B. Carcinoma of the bladder LIremia 



Autopsy 



No 

No 
Yes 



196 BULLETIN OF THE SCHOOL OF MEDICINE. U. OF AID. 

NEUROLOC;iC SURGERY 

This division, as it now exists, came into being in 1954 when Dr. James G. Arnold, 
Jr. was appointed head of the division. Since that time ert'orts toward reorganization 
and improvement in student teaching capacity as well as in the teaching of an increased 
house officer training load haxe been painfully slow. Somewhat more than one year 
ago the entire unit was moxed along the fourth floor wing into the Psychiatric area to 
a 34-36 bed patient site. This was an important and long overdue step and gave to this 
division a unit for specialized teaching, training and patient care which had been a 
long sought goal. However, the moxe brought with it problems which to date have 
remained insurmountable. Only 75 per cent of the unit's bed capacity has been utilized 
because of failure to provide nursing care for more than this number of patients. 
Perhaps the greatest and most urgent reason for moving into this new area was the 
gaining of some freedom for admission of ward patients. This aspect of the transfer 
has been wholly defeated. There are now no more ward patient teaching beds than 
heretofore. The move has freed beds, however, for other services who now occupy 
these released beds and this has been a helpful effect. At the time of submission of 
this report, ward patients are allocated seven beds in this area, an occupancy of 26 
per cent of the total utilizable bed area. This lack of training and teaching material 
will shortly affect the adequate training of house officers and, equally important, the 
ability of this service to attract men of high caliber for training under its direction and 
superintendence. 

This division is unusual and almost unique in that a large emphasis upon pediatric 
neurologic surgery exists as a result of the skill and interest shown in this field by Dr. 
Robert M. N. Crosby. Much of the teaching and instruction in this highly specialized 
aspect of neurosurgery is under his supervision. 

A major goal for this division is the providing of a greater ward ser\'ice area. The 
geographic location and segregation of these patients is ideal and affords the opportunity 
of an excellent service for specialized care and training. A corollary to this increased 
patient load will be a large increase in the out-patient census making this a most 
valuable diagnostic and teaching area. At this moment the out-patient load is minimal 
and inadequate for a large teaching load. Student teaching in this division is limited, 
but for those senior students assigned to the service, intense. Contact with junior 
students comes about only through prepared lectures given in the second semester. In 
the senior year, one-fourth of the class is assigned to this di\'ision for a period of one 
month or one-half the section time. Teaching is carried on through daily ward rounds 
and a series of conferences which include neuroradiology and neuropathology, neur- 
ology and electroencephalography. The training of house officers has followed the usual 
pattern on clinical ser\'ices at the LIni\'ersity Hospital, Mercy Hospital and the Fort 
Howard Veterans Hospital to each of which places members are assigned in rotation. 

Trainees in neurologic surgery arc rccjuired to de\'otc one year to neuropathology, 
neuroanatomy, and electroencej)halography. The trainee works throughout the year 
and takes a complete course in neuroanatomy, attends weekly conferences in encephal- 
ography and spends an hour weekly in the EEG laboratory. Dr. Robert Moore, Hoff- 



DEPARTMENT OF SURGERY 197 

berger Fellow, in neurosurgery (1956-1957) was a trainee on this program during the 
past \'ear. 

Six months of a neurosurgical house officers training is devoted to'clinical neurology. 
He is encouraged to undertake this training with another institution in order to broaden 
his contacts and experience. During the past year, Dr. John O. Sharrett recei\'cd this 
training at the National Hospital, Queen's Square, London, England. 

The research activities of this di\'ision have been supported by two sources: 

(1) $15,000— Neurosurgical Research Fund (Mt. Ararat Foundation) 

(2) $ 5, 000-Hoff berger Research Fund 

During the past year Mr. Charles M. Henderson has been a student Fellow in the 
Di\'ision of Neurologic Surgery. 

CURRENT RESEARCH PROBLEMS 

1. Subarachnoid Cysts— A clinical and pathologic evaluation. 

James G. Arnold, Jr., Dorcas H. Padget, William FI. Mosberg and 
John O. Sharrett* 

2. Studies on Intracranial Pressure. 

Raymond K. Thompson and Charles M. Henderson''''*' 
3>. The treatment of intracranial aneurysm under hypothermia and total arterial 
occlusion. 
James G. Arnold, Jr. and Raphael Longo 

* House Officer 
** Student Fellow 

CURRENT PUBLICATIONS 

1. Crosby, R. M. N. and Dennis, J. M.: Subdural collections of fluid in infants and children. 

I. Visualization of the capsule with thorium dioxide, 

Am. J. Roent., Radium Therapy and Nuclear Med. LXXVI: 3, (September) 1956. 

2. Crosby, R. M. N. and Bauer, R. E.: Subdural collections of fluid in infants and children. 
II. Study with radioactive sodium phosphate. 

Jour, of Neurosurg., XIII: 2, 140-144, 1956. 

3. Wagner, J. A. and Sharrett, J. O.*: Ischemic hypophyseal necrosis and other pituitan,' 
lesions: Incidence in a moderately large autopsy series. 

So. Med. J., 49: 7, 671-678, (July) 1956. ' 

4. Padget, D. H.: The development of the cranial \enous system in man, from the standpoint of 
comparative anatomy. 

Carnegie Inst, of Washington Publ. 61 1, Contrib. to Embryol., 36, in press, 1957. 
In Preparation: 

Mosberg, W. H.: Extracranial lesions commonly associated with head injuries. 

* House officer 

PAPERS COMPLETED AND READY FOR PUBLICATION 

1. Mosberg, W. H. and Sherwood, S. L.: Catatonic patients treated with cholinesterase. 

2. Mosberg, W. H. and Lindenberg, R.: Traumatic hemorrhage from the anterior choroidal 
artery. 

3. Wagner, J. A. and Sharrett, J. O.*: Ischemic h\'pophyseal necrosis associated with increased 
intracranial pressure. 



198 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF AID. 

4. Kiel and Siiarrett, J. O.*: Amputation neuroma ocular motor nerve secondary to ruptured 
aneurysm: with partial regeneration. 

5. MosBERG, VV. H. and Sharrett, J. O.*: Epidural abscess of forty years duration. 

6. Scarborough and Sharrett, J. O.*: Rib graft cranioplasty. 
* House officer 

RESIDENT STAFF 

Resident 

Dr. Rafael Longo-Cordero 

Assistant Residents Hojfherger Fellow 

Dr. Herbert S. Bell (2) t^ d u a A.f 

-^ ,, „, „ , ,,. Dr. Kobert A. Moore 

Dr. Yong Won Suh (1) 

Dr. Steven S. Malina (1) 

T^ T 1 TT TT7 . ^,N btudcnt teliow 

Dr. Israel H. Wemer (1) 

Dr. Paul C. Hudson (1) Charles M. Henderson 

STAFF ACTIVITIES 

R. M. N. Crosby, M.D. 

Elected member of the Advisory Board of the Maryland Society for Mentally Re- 
tarded Children (Fall of 1956) 
Elected member of Southern Neurosurgical Society— March, 1957 
Chosen member of the Harvey Cushing Society— April, 1957 

William H. Mosberg, Jr., M.D. 

Elected member of Southern Neurosurgical Societv— March, 1957 
Chosen a member of the Harvey Cushing Society— April, 1957 
Appointed to Editorial Committee of the Congress of Neurological Surgeons- 
August, 1956 

Raymond K. Thompson, M.D. 

Elected Vice President of the Congress of Neurological Surgeons— November, 1956 
Delegate of the Congress of Neurological Surgeons to the International Congress of 
Neurological Sciences, July, 1957 

James G. Arnold, Jr., M.D. 

Elected member of the American College of Surgeons— October, 1956 

Elected to the Society of Neurological Surgeons— May, 1957 

Elected Vice President of the Southern Neurological Societv— March, 1957 

LECTURES AND COMMUNITY SERVICES 

Dr. James G. Arnold, Jr. 

Southeastern Pennsylvania branch of the American College of Surgeons, April 6, 
1957, at York, Penna.: 

"Diagnosis and treatment of craniocerebral injuries" 
Panel discussion. Moderator, Southern Neurosuroical Societv, March 16, 1957, at 
Nashville, Tenn. 
Dr. Raymond K. Thompson 

Maryland Association of Industrial Nurses, Stafford Hotel, September, 1956: 



DEPARTMENT OF SURGERY 199 

"Neurosurgical Problems in Industry" 
Franklin Square Hospital House Staff and Surgical Staff, September, 1956: 

"Common neurosurgical diseases" 
Surgical Staff Conference, St. Agnes Hospital, April, 1957: 
"Treatment of Craniocerebral Trauma" 
House Staff, Maryland General Hospital, April, 1957: 

"Accident room management of the acute head injury" 
Dr. R. M. N. Crosby 

East Baltimore Medical Society, September, 1956: 

"Neurosurgery in Children" 
Parents Group of the Searchlight School, Fall, 1956: 

"Mental Retardation and Its Causes" 
PTA School of the Chimes, January, 1957: 

"Mental Retardation and Its Causes" 
2 Radio and 2 Teleyision programs in November, 1956 for the Maryland Society for 
Mentally Retarded Children 
Dr. William H. Mosberg, Jr. 

(Springfield State Hospital, Sykesville, Md.— Staff Meetings) 
1/25/57 Psychosurgery 
2/ 8/57 Vascular lesions of the brain 
2/15/57 Head Injuries 
2/22/57 Spine Injuries 
3/ 8/57 Herniated intervertebral disks 
4/12/57 Brain tumors 

(South Baltimore General Hospital— Surgical Staff) 
2/ 5/57 Spine Injuries 

(Maryland General Hospital— Surgical House Staff) 
3/20/57 Spine Injuries 
4/ 3/57 Head Injuries 
4/24/57 Vascular lesions of the brain 

(St. Agnes Hospital-Medical Staff Meeting) 
3/27/57 Vascular lesions of the brain 

(St. Agnes Hospital— Surgical Staff Meeting) 
5/ 8/57 Vascular lesions of the brain 

(St. Joseph's Hospital— Surgical House Staff) 
5/15/57 Surgical Management of Head Injuries 



200 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 



NEUROSURGERY 

Private 
Cranial Surgery: 

Craniotomy tor tumor rcmoxal 37 

Ci"aniotom\', subdural membrane removal 6 

Trephines, meningeal exploration 29 

Trephines, evacuation brain abscess 2 

Craniotomy, evacuation of abscess 

Craniotomy, intracranial aneurysm ligation 6 

Craniotomy for hemispherectomy 1 

Trephines, prefrontal lobotomy 1 

Craniectomy, cranial nerve section 7 

Craniectomy for sequestectomy 

Craniotomy for electrocorticogram 2 

9\ 

Vertebral Column and Spinal Cord Surgery: 

Cervical laminectomy for Kahn procedure 2 

Cervical interlaminal exploration for discectomy 15 

Lumbar interlaminal exploration for discectomy 142 

Lumbar laminectomy for discectomy 10 

Laminal exploration for release of adhesions 3 

Disc exploration and spinal fusion 4 

Laminectomy for vertebral column tumor or disease 15 

Laminectomy for spinal cord tumor 4 

Laminectomy for tractotomy 7 

202 
Congenital Malformation Surgery: 

Meningocele-myelomeningocele repair 2 

Cranial osteotomy 

Spinal shunts 

Ventricular shunts 2 

Traumatic Neurosurgery: 

Application of Raney-Crutchfield tongs (O.R.) 

Craniectomy for subtemporal decompression 

Craniectomy for therapeutic section of tentorium 

Craniotomy for ele\'ation of depressed skull fracture 9 

Craniotomy for cranioplasty 5 

Debridement and plasty of scalp lacerations 2 

Debridement and decompression of spinal fracture 

Laminectomy for removal of foreign body (cord) 

~i6 



Clinical 

10 
22 
44 

4 

1 

4 

1 

1 



1 

1 

"89 


2 
21 
1 

1 
4 
3 
4 

"36 

1 





19 

20 


3 
4 
9 
2 

1 
2 

~2\ 



DEPARTMENT OF SURGERY 



201 



NEUROSURGERY 

(Concluded) 

Private Clinical 

Peripheral Nerve Surgery 4 2 

N etiro-Roentgen-Ray Diagnostics: 

Trephines and ventriculogram 12 7 

Ventriculography without trephines 3 5 

Pneumoencephalography 68 47 

Angiography (arteriogram) 44 26 

Melography 192 33 

Discographv 

Sinography 

319^ 118 
MisceUaiieous: 

Scalenotomy 1 

Exploration lumhar sinus I 

Craniectomy, gunshot wound, skull 1 

Lymph node biopsy 1 

Excision hemangioma scalp 1 

Skull biopsy 1 

Craniectomy and debridement for postoperati\'e wound 

infection 1 

Excision intracranial tumor 1 

Thoracolumbar sympathectomy 1 

Excision anterior iliac spine 1 

Removal tantalum plate 1 

Excision tumor scalp 1 

Excision bony cyst, parietal area 1 

Incision and drainage, head wound 1 

Incision and drainage of back 1 

Excision of exostosis of skull 1 

Osteotomy of sagittal suture 1 

Frontal craniotomy for meningocele repair 1 

Ligation common carotid, left 1 

Needle biopsy, C5 1 

Excision dermoid cyst, scalp 1 

Closure ccr\ical laminectomy dehiscence 1 

16 ~6 
Siiumiary: 

Operati\'e procedures 333 174 

Roentgen-Ray diagnostics 319 118 

652 292 



202 



BULLETIN OF THE SCHOOL OF MEDICINE, IJ. OF MD. 



OPERATIVE DEATHS-SURGICAL SPECIALTIES 

CLINICAL SERVICE 

Neurosurgery: 1 1 



Hosp. No. Initial Primary Diagnosis 

101-8-79 W.L. 



Operation 



Cause of Death Autopsy 



099-7-86 B.H. 



106-4-93 J.S. 



101-9-87 L.E. 



108-6-81 A.S. 

107-9-76 C.F. 

107-7-88 G.G. 

134-1-95 CO. 

135-7-62 H.B. 

134-6-36 L.B. 

051-5-99 E.N. 



Subtemporal 
decompression 



Craniotomy 
Tentorial section 



Craniectomy, 
temporo frontal 
left 

Ventriculo ureteral 
shunt 



Cerebral edema Yes 



Cerebral edema No 



Cerebral 
lacterations 
and contusions 

Meningitis 



Subdural 

hematoma 
Cerebral 

contusion 
Subarachnoid 

hemorrhage 
Probable ruptured 

intracerebral 

aneurysm 
Gunshot wound, 

head 

Klippel-Feil 

syndrome 

Meningocele 

(Cervical, 

occipital) 
Cerebral contusion Bilateral trephines Cardiac failure 
Cerebral concussion 
Multiple fractures, 

extremities 
Cranio cerebral Subtemporal Cerebral edema 

trauma 
Subdural 

hematoma 
Brain tumor 

suspect 



Med. 
Exam. 

No 



Subtemporal 
decompression 
and tentorial 
section 

Craniotomy 



Metastatic brain 

tumor 
Subdural 

hematoma 

Subdural 
hematoma 
chronic, right 

Angioma, frontal 
right with 
hemorrhage 



Trephine 

ventriculogram 
Bilateral 

subtemporal 

decompression 
Trephines, right 
Temporal 

craniectomy 
Tentorial section 
Craniotomy 
Excision of 

angioma 



Encephalomalacia 
due to cerebral 
infarction 

Primary diagnosis 

Cerebral edema 



Primary diagnosis 



Brain abscess 
Meninoitis 



Med. 
Exam. 



Med. 
Exam. 



Yes 



No 

Med. 
Exam. 

Med. 
Exam. 



Yes 



DEPARTMENT OF SURGERY 



203 



OPERATIVE DEATHS-SURGICAL SPECIALTIES 

PRIVATE SERVICE 

Neurosurgery: 18 



Hosp. No. 


Initial 


Primary Diagnosis Operation 


Cause of Death 


Autopsy 


10L2-69 


M.S. 


Aneurvsm, internal Ligation 
carotid artery 


Cerebral edema 
Cerebral softening 


Yes 


098-6-18 


S.N. 


Glioma, left frontal Craniotomy 
lobe Biopsy 


Primary diagnosis 


Yes 


101-3-05 


H.L. 


Glioma, left Expl. craniotomv 


Cerebral edema 


No 



101-7-08 D.C. 

106-5-52 S.L. 

096-6-34 W.A. 

110-1-60 G.S. 

108-7-79 J.T. 

101-6-34 A.B. 

136-0-33 S.S. 

057-7-11 E.W. 



109-9-79 H.B. 
134-1-18 O.C. 



temporal lobe Evacuation 

gliomatous cyst 

Arnold Chiari mal Craniectomy 
formation (cerebellar) 



Brain tumor 

suspect 
Encephalomalacia 

Brain tumor 

Tumor of 3rd 
ventricle 

Encephalitis, 
chronic non 
specific 

Spongioblastoma 
multiforme 

Parieto occipital 
right 

Meningioma 
sub tentorial, 
left 



Intracranial 
aneurysm, 
middle cerebral, 
right 

Astrocytoma 

Glioma, tempero- 
occipital, right 



Craniotomv 

(frontal parietal 
right) 

Craniotomy 

Torkildeson 
procedure 

Trephine 

Aspiration 

Biopsy 

Craniotomy 
Biopsy 



Laminectomy 

cervical 
Partial resection 

of tumor 

Excision aneurysm 



Partial crancctomv 

Occipital 
lobectomy 



Cerebral edema 
Uncinate 
herniation 

Broncho 
pneumonia 

Cerebral edema 
Cerebral edema 



Yes 

No 

No 
No 



Primary diagnosis No 



Primary diagnosis Yes 



Primary diagnosis Yes 



Aspiration Yes 

exphexia 
Encephalomalacia 

Primary diagnosis No 
Cerebral edema Yes 



204 



BULLETIN OF THE SCHOOL OF MEDICINE, L/. OF AID. 



OPERATIVE DEATHS-SURGICAL SPECIALTIES 

PRIVATE SERVICE 



Hosp. No. Initial 



Primary Diagnosis 



Operation 



Cause of Death Autopsy 



098-3-61 CD. 



1097-62 F.K. 



109-2-11 A.K. 



136-4-80 A.Z. 



136 9-91 A.L. 



Brain abscess, 
temporal 

Cranio cerebral 
trauma with 
fractured skull 
depressed 

Multiple 
lacerations 

Hemorrhage 

Paravertebral 
abscess second- 
ary to metastatic 
carcinoma, clear 
cell, renal 

Intercranial 

aneurysm 
Middle cerebral 

ruptured 

Ruptured 
intracerebral 
aneurysm 



Primary diagnosis No 



Primary diagnosis Yes 

Exam. 



Trephine 
Aspiration of 
brain abscess 

Subtemporal 
decompression 

Elevation of 
depressed 
fractures 



Laminectomy Primary diagnosis Yes 

Decompression of Cardiac failure 
cord Lobar pneumonia 



Cerebral edema No 



Craniotomy 
Clipping 
aneurysm 



Ligation of Primary diagnosis No 

aneurysm under 

hypothermia 
Control cerebral 

blood flow 



Neiirosxirgery: 1 



NONOPERATIVE DEATHS 

CLINICAL SERVICE 



Hosp. No. Initial 



Primary Diagnosis 



Cause of Death 



Autopsy 



107-2-22 A.T. 



Gunshot wound, brain 
Subdural hematoma 



Primary diagnosis 



Med. 
Exam. 



DEPARTMENT OF SURGERY 205 

NONOPERATIVE DEATHS 

PRIVATE SERVICE 

Nenrosiiroery: 6 

Hosp. No. Initial Primary Diagnosis Cause of Death Autopsy 

100-8-79 L.H. Intercranial aneurysm, middle Hemorrhage Yes 

cerebral artery 

056-0-51 W.H. Metastatic carcinoma of die Probable congestive No 

brain failure 

074-3-52 J.L. Astrocytoma Primary diagnosis Yes 

Diencephalon Cerebral edema 

108-4-08 B.M Gunshot wound of the brain Primary diagnosis Med. 

Exam. 

134-9-62 P.M. Ruptured intracerebral Primary diagnosis No 

aneurysm 
107-0-47 C.H. Carcinoma of the lung Carcinomatosis 

Metastasis to thoracic spine 

Paraplegia 



No 



THORACIC SURGERY 

The division of thoracic surgery has undergone a variety of changes in the more 
than one and one-half years since the appointment of Dr. R. A. Cowley as its head. In 
that time a large and ever increasing importance is being given to cardiac and cardio- 
vascular surgery. Most of this work is concentrated in the research laboratory and on 
the surgical wards at University Hospital. Increasing importance is being given to our 
thinking with regard to this surgical specialty at Mercy Hospital where emphasis upon 
non-tuberculous pulmonary and esophageal disease can be concentrated. Finally, in 
September, 1956, a surgical tuberculosis floor was opened at the Mount Wilson Sani- 
torium in Baltimore where experience in the treatment of tuberculosis is concentrated. 

A two-year residency program is given qualified candidates who wish to become 
proficient in the field of thoracic surgery. This program is under the direction and 
superxision of two full-time ph\sicians. Dr. R. A. Cowley and Dr. Bruce Armstrong 
at University Hospital and two part-time physicians, Dr. William Garlick at Mercy 
Hospital and Dr. John Miller at Mount Wilson Sanitorium. Work in the Research 
Laboratory at the University is under the direction of Drs. Cowley and Armstrong, and 
Dr. William Esmond on a part-time basis. 

This division, too, is sharjily handicapped by lack of jiaticnt bed space. Such patients 
as are admitted to this serxice require often a detailed and sometimes tedious preopera- 
tive period of diagnostic investigation. Thus, a bed capacity capable of handling 12-15 
jiatients would more nearly approach this di\'ision's needs than do the 4-6 now 
axailable. A partial, but wholK' unsatisfactory, solution of this need has been the 
availability of beds on the medical floors for the use of cardiac patients undergoing 
diagnostic work-up or undergoing surgical care and treatment. This arrangement has 
provided excellent care from the combined surgical and medical staff^s for these patients, 



206 BULLETl}^ OF THE SCHOOL OF MEDICINE, U. OF MD. 

but has placed an undesirable burden upon these floors that do not easily accommodate 
patients who require surgical treatment, dressings, etc. Fortunately, a minimum of 
friction has de\eloped o\er the limits of responsibility of the two staffs. 

Further difficulties ha\'e developed, from time to time, at Mercy Hospital. The slow 
development of a thoracic surgerv ward service can be attributed in large measure to 
a lack of industrv. a minimum of a\ ailabilitv and a misinterpretation of the functions 
of residents sent to this hospital for thoracic surgical training. In general, there appears 
to be little intermingling of men in the two disciplines and therefore little concern and 
appreciation each of the other. Perhaps the severest limitation is the lack of assigned 
beds for thoracic surgerv— the result, as was anticipated, has been some acrimonious 
bickering between house officers. Until such allocation can be agreed upon, little hope 
of improving this ser\ice seems to be possible. 

The clinical facilities at Mount Wilson are hampered little or not at all bv the 
availabilitv of beds. On the other hand the surgical nursino staff has been torn bv 
internal quarreling and dissatisfaction which has sharplv limited its efficiencv and 
effectiveness and has gained for the Uni\ersitv nursing group little commendation for 
a job reasonablv well done. Some limitation of funds has curtailed frequent anesthesia 
staff coverage, so that operations are done on two week davs only. It is anticipated that 
this coverage can be increased in the coming vear. 

The teaching activities in the medical school of this division are limited largelv to 
the senior year when one-fourth of this class is assigned to it for a period of four weeks. 
A series of lectures comprises its teaching in the junior vear. 

A series of lectures to nurses is given at frequent intervals during the vear for a 
small group of nurses wishing to specialize in thoracic surgical nursing. 

Within this division and with the assistance of Dr. Bruce Armstrong, cardio- 
pulmonarv function laboratories have been set up and are functioning at the Universitv 
Hospital. Mercy Hospital and Mount Wilson Sanitorium. In each of these areas an 
improvement and increased availabilitv of equipment and apparatus is gradually 
becoming apparent. Shortlv an additional space within Universitv Hospital will be 
devoted solely to detailed pulmonary function studies. 

* * * 

RESIDENT STAFF 

Reside}it 
Dr. Santiago Lombano 

Assistant Residents 
Dr. Paul M. DiGiorgi 
Dr. Toufic E. Haddad 
Dr. Charles G. Peagler 

LECTURES AND COMMUNITi' SERVICES 

Dr. R. A. Cowley 

1. "Selective Vagotomv in Coronarv Vascular Disease"; Cologne, Germany; August 
20, 1956 

2. "Vascular Surgery"; St. Agnes Hospital, Baltimore, Mar)'land; September 2, 1956 



DEPARTMENT OF SURGERY 207 

3. "Surgery for the Cardiac Patient"; Delaware Academy of General Practice, Wil- 
mington, Delaware; September 26, 1956 

4. "Pulmonary Evaluation"; Delaware Academy of General Practice, Wilmington, 
Delaware; September 26, 1956 

5. "Cardiac Surgery"; Maryland Academy of General Practice, Belvedere Hotel, 
Baltimore, Maryland; October 18, 1956 

6. "Surgery for Mitral Stenosis"; Maryland Chapter Vocational Rehabilitation, Emer- 
son Hotel, Baltimore, Maryland; October 23, 1956 

7. "Surgery for Coronary Insufficiency"; Doctors Hospital Post-Graduate Institute, 
Baltimore, Maryland; November 13, 1956 

8. "Surgical Aspects— You and Your Heart"; Macht Assembly Hall, Baltimore, Mary- 
land; December 12, 1956 

9. "Heart Surgery"; WAAM-TV, Baltimore, Maryland; February 14, 1957 

10. "Occlusive Vascular Disease of the Great Vessels"; South Baltimore General Hos- 
pital, Baltimore, Maryland; February 24, 1957 

11. "Current Aspects of Heart-Lung Apparatus in Cardio-Pulmonary Surgery"; Provi- 
dent Hospital, Baltimore, Maryland; April 25, 1957 

RESEARCH PROJECTS AND INVESTIGATIONS 

1. Blood Oxygenator Dialysis Device, Grant No. H-2618, U. S. Public Health 
Service. Dr. William Esmond 

2. Origin and Effect of Ammonia in Shock, Army Contract No. DA-49-007-MD-674. 
Dr. R. A. Cowley 

3. A Study of the Metabolic Requirements of Cardiac Tissues under Certain Neuro- 
genic and Metabolic Stress States and Developing and Perfecting a Mechanical 
Metabolic Exchange Apparatus, Army Contract No. DA-49-007-MD-737. Dr. 
William Esmond 

4. A Study of the Metabolic Requirements of Tissues under Varying Conditions, 
Army Contract No. DA-49-007-MD-654. Dr. R. A. Cowley 

5. Perfection of Bubble Type Oxygenator. Bressler Reserve Fund. Dr. R. A. Cowley 

6. Effect of Vagal Stimulation on the Coronary Arteries. Drs. R. A. Cowley and L. 
Scherlis 

7. Origin and Utilization of /Xmmonia during Hypothermia for Cardiac Surgery. 
Dr. R. A. Cowley 

8. Relationship in Time between S\ mptomologv, Diagnosis and Treatment in Refer- 
ence to Cancer of the Lung. Drs. R. A. Cowley and T. Haddad 

9. Effect of yXntibiotics on the Surxixal of Dogs in Acute Coronary Occlusion. Dr. 
R. A. Cowlc)' 

PAPERS PUBLISHED 

1. Allen, J. M. and Cowley, R. A.: A new vascular instrument for repair of saccular aneurysms, 
Bulletin of School of Medicine, University' of Maryland, 41: No. 3, (July) 1956. 

2. ScHiMERT, G.: A simple type of bubble oxvgenator. Surgery, (December) 1956. 

3. ScHiMERT, G. and Cowley, R. A.: Defibrillation, cardiac arrest, and resuscitation in deep 
hypothermia by electrolyte solutions. Surgery, (February) 1957. 

PAPER SUBMITTED 
1. Cowley, R. and Scherlis, S.: Selective vagotomy in the treatment of coronary artery disease, 
submitted for publication in Diseases of the Chest. 



208 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 



THORACIC SURGERY 

Lung and Pleura: 

Pleural biopsy 

Lung biopsy 

Luno abscess drainaoe 

Lobectomy 

Lobes plus segmentals 

Segmentals 

Pneumonectomy 

Wedge resection 

Decortication 

Thorax: 

Funnel chest repair 

Rib biopsN' 

Stab and gunshot wounds 

Empyema drainage 

Excision sinus tract 

Cervical rib 

Pericardial biopsy 

Hiatus hernia 

Thoracoplasty (initial) 

Thoracoplasty (concommitant) 

Cardio-V asciilar: 

Aortic valvulotomy 

Chanelization abnormal 

Pulmonary vein 

Patent ductus 

Mitral commissurotomy 

Pulmonic valvulotomy (isolated) 

Pulmonic valvulotomy (combined) 

Aortic coarctation 

Interatrial defect (isolated) 

Interatrial defect (combined) 

Tetralogy 

Pericardiopexy (Beck 1) 

Selective vagotomy plus Beck 1 

Internal Mammary Artery Ligation 

Vascular ring 

Superior vena caval s\ ndrome 

Femoral A.V. fistula 

Femoral acute— acute 



Private 



Clinical 



2 


4 


5 


10 





3 





66 





21 


1 


47 


5 


22 


3 


4 


3 


2 



29 



1 

2 
15 
4 
4 
3 
6 
4 
2 
3 
7 



179 



3 


2 





2 





11 


2 


10 





1 


1 








2 


5 


2 





17 


1 


10 


12 


57 



DEPARTMENT OF SURGERY 
THORACIC SURGERY 

(Continued) 

Aortic aneurysms graft 

Adrenalectomy and sympathectomy (bilateral) 

Esophagus: 

Esophagogastrectomy 

Colon transplant 

Ligation varices 

Foreign bodv removal 

Di\'erticulum 

Esophagoscopy 

Vagotomy 

Mcdiaslininu: 

Drainage 

Remo\'al cyst or tumor 



209 



'rivate 


Clinical 


3 





2 


1 


64 


13 


3 


5 





3 





1 


1 


1 


2 





4 


28 


1 





IT 


38 


1 


4 


2 


2 


~^ 


~6 



OPERATIVE DEATHS-SURGICAL SPECIALTIES 

CLINICAL SERVICE 

Thoracic Surgery: 5 



Hosp. No. 


Initial 


Primary Diagnosis 


Operation 


Cause of Death 


Autopsy 


101-3-43 


H.S. 


Squamous 
carcinoma of 
the esophagus 


Esophagogas- 
trostomy 


Mediastinitis 


No 


101-5-79 


H.R. 


Carcinoma of the 
left lung 


Thoracotomy 
Biopsy 


Primary diagnosis 


Yes 


116-5-79 


C.P. 


Squamous cell 


Resection 


Mediastinitis 


Yes 






carcinoma, 


Reconstruction 


secondary to 








middle 3rd of 


of esophagus 


perforation, 








esophagus 


with right colon 


esophagocolic 

jimction 




109-7-61 


M.B. 


Lannaec's cirrhosis 


Trans thoracic 


Mediastinitis 


Yes 



108-2-69 C.B. 



Bleeding ligation of 

esophageal esophageal 

\'arices \'arices 

Pulmonary abscess Right lower lobe 

right lower lobe lobectomy 



Septicemia 
Perforation of 

the esophagus 
Mediastinitis 



Yes 



210 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 



OPERATIVE DEATHS-SURGICAL SPECIALTIES 



PRIVATE SERVICE 



Thoracic Surgery: 3 



Hosp. No. Initial Primary Diagnosis 



Operation 



Cause of Death Autopsy 



099-6-56 J.M. 



108-5-64 A.T. 



080-1-58 T.K. 



Carcinoma of the Right Spontaneous Yes 

lung, right pneumonectomy pneumothorax, 

left 

Aneurysm, Excision aneurysm Atelectasis, right No 

abdominal aorta Bifercation massive 

Graft 



Congenital heart 

disease 
A.V. communis 
Infundibular 

stenosis 
Double superior 

vene cava 



Right 

ventriculotomy 

Repair of I.V. 
septal defect 

Repair infundi- 
bular stenosis 



Electrolyte 
imbalance 



Yes 



Thoracic Surgery: 2 



NONOPERATIVE DEATHS 

CLINICAL SERVICE 



Hosp. No. Initial 



Primary Diagnosis 



Cause of Death 



Autopsy 



134-9-71 R.R. 
095-8-35 W.K. 



Coronary insufficiency 



Primary diagnosis 



Carcinoma of the esophagus Primary diagnosis 

with perforation 
Secondary lung abscess 



Yes 

No 



Thoracic Surgery: 2 



NONOPERATIVE DEATHS 

PRIVATE SERVICE 



Hosp. No. Initial 



Primary Diagnosis 



Cause of Death 



Autopsy 



134-3-36 F.T. 
135-4-96 A.U. 



Pulmonic stenosis Convulsive seizure Yes 

Interventricular septal defect Post cardiac catheterization 



Carcinoma of the right lung Cerebral metastasis 



No 



DEPARTMENT OF SURGERY 211 

OTOLARYNGOLOGY 

The division of otolaryngology has begun already to change under its new leader- 
ship. Joining the Department of Surgery in mid-April, Dr. Cyrus L. Blanchard became 
a full-time member of the staff and head of this di\'ision. Dr. Blanchard was born in 
Massachusetts, received his college degree at Clark Uni\'ersity in Worcester and his 
M.D. degree from the George Washington LIni\'ersitv in Washington, D. C. His 
training in otolar\ ngologv was begun at the Memorial Hospital in Worcester, Massa- 
chusetts, was continued through the period of his Army service at the Audiology and 
Speech Correction Center, Walter Reed General Hospital and was completed at the 
University of Michigan, in Ann Arbor, in 1953. Just prior to coming to Maryland, 
Dr. Blanchard was an assistant in surgery, in the Department of Otolaryngology, at 
the School of Medicine, LIniversitv of Southern California. 

With the advent of a full-time head of this division it is unquestioned that many 
of the present worrisome problems can be ironed out or made unimportant by his 
constant attention and industry. 

One of the gra\'e defects existing at the moment within this di\'ision is its lack of 
physical facilities necessary for the full realization of its capacity. Through the very 
generous support of the Women's Board of the LIniversity Hospital sufficient funds 
were made available to this division for the purchase and installation of an audiometric 
testing room in the Looper Clinic. This, with supplementary sound-proofing of the 
area will admit an almost ideal unit for hearing testing and acuity evaluations and can 
be made of sufficient accuracy by minimal additional sound-proofing that it will permit 
considerable basic clinical research to be done upon hearing. 

When this area has been put into use, further revision of the Otolarx ngology Clinic 
in the out-patient building must be begun. It is hoped that: 

(1) The present otolaryngology clinic and the now unused ophthalmology clinic 
area can be combined. 

(2) Both areas may be renovated to admit not only clinic, but also private patients 
for examination, because: 

(3) By this means only, practical, efficient and effectixe use may be made of part- 
time associates in the division. 

(4) Means will be made axailablc for the installment of one or two audiometric 
testing units in this area. 

(5) Because of the immediate and close alignment of speech and hearing defects, 
a part-time audiologist can be assigned to this di\ision from the Department 
of Speech at College Park. 

(6) Additional equipment can be made a\ailable for the out-patient area. 

An early step towards the utilization, to the fullest of the out-patient potential, is 
the increased clinic time; as of July 1. this unit will be open a full four half-days per 
week, instead of three. It is anticipated that shorth-, thereafter, it will be opened daily. 

The logical sequence of an increasing diagnostic load will be a longer and larger 
number of patients who require hospitalization for surgical therapy. It seems incon- 
ceivable that this di\ision exists at the moment on four adult ward sureical beds and 



212 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

an occasional child's bed, wrung Irom a \cliemcntly protesting general surgery resident. 
Some ]iro\isions }uust be made lor additional beds for resident staff training, for 
teaching anti lor patient care. 

It is apparent that with this anticipated a\ailabilitv of diagnostic and treatment 
facilities in both the out-patient building and in the Looper Clinic within the hospital, 
plus a hoped-for addition of patient beds, this division may offer a superb clinical 
training for its house officers. In the several years preceding this an otolaryngology 
resident staff was not available. The present resident joined the division on No\'ember 
1, 1956, coming to this hospital after uncompleted work in otolaryngology with the 
Armed Services. With the beginning of this resident has come the setting-up of a 
responsible and more or less capable system from which point it is now anticipated 
additional men can be added to begin their three years of clinical otolaryngologic 
training. Into such a fully organized program can then be added lecture and laboratory 
courses in anatomv and pathologv of the normal and diseased ear, the physiology of 
the ear and the effect of drugs upon the normal and diseased ear. 

Perhaps the gra\'est concern o\'er this di\'ision by other members of the Department 
of Surgerv has related to student teaching. A good effort has been made bv the men 
in the division, but upon a part-time basis. This program did not permit a constancv 
or closeness of contact and supervision sufficient to make the service attractixe or 
appealing. Perhaps the gravest impressive defect upon senior medical student ward 
rounds was the great lack of clinical material. This lack required a return to didactic 
lecturing, of which these critical novices had had more than enough in their preceding 
medical school vears. With the projected expansion in clinical diagnostic facilities and 
the undertaking of a graded residencv training program, much of the teaching of junior 
and senior students can be directed towards an improved knowledge and awareness of 
otologic diagnosis. The value of such knowledge can be experienced onlv bv bedside 
patient contact and it is here again that strenuous planning must be undertaken. 

GIFTS AND DONATIONS 

Women's Auxiliarv Board of the Universitv Hospital— $5,667.00, for the purchase 
of Audiometric Testing Equipment. 

RESEARCH 

At this moment no organized research program is in being. Planning for such may 
take several directions and discussions are underwav at this moment to determine 
whether this shall be of a basic nature or established at the level of clinical detection, 
evaluation and rehabilitation. 



RESIDENT STAFF 

Resident 
Dr. Gene Trettin 



DEPARTMENT OF SURGERY 
OTOLARYNGOLOGY 

Private 
External Ear: 

Malignant tumors-excision 

Mastoidectomy: 

Simple 3 

Radical 5 

"8 

Intranasal Operations: 

Submucous resection of septum 2 

Removal of nasal polyps 1 

Antrotomy 4 

~7 

ExterimJ Sinus Operations: 

Antrum— radical 1 

Definitive Operations for Malignant Tumors: 

Oral cavity 1 

Mandible and adjacent structures 1 

Superior maxilla 

^2 
Tonsillectoviy and Adenoidectouiy: 

Tonsillectomy and adenoidectomv— children 90 

Tonsillectomv— adults 5 

Hare Lip— plastic repair 

Adenoidectom\— adults 5 

100 
Laryngeal Operations: 

Laryngoscopx— dell nit i\c rcmo\al of benign tumor or 

nodule 97 

Total larvngcctonn 5 

loi 

Tracheotomy 2 

Bronchoscopy— diagnostic or therapeutic 155 

Esophagoscopy— diagnostic or therapeutic 97 



213 

Clinical 
1 





1 
1 

~2 

90 
2 
1 


"93 



25 
1 

1 

47 

4 

"52 



214 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF AID. 

SUMMARY 

It is to be noted that in the diseursive account of the Department of Surgery for 
the past twelve months, some needs and trends are common and reiterated for each 
division within the department. Some of the trends are of necessity and are not neces- 
sariK representati\e of an ideal directional concept. Perhaps the most important concept 
implied is that this department will flourish most abundantly when the teaching of 
house ofKcers and students can, for the most part, be accommodated in one area— the 
LInixersitv Hospital and the School of Medicine of the Llnixersity of Maryland. The 
utilization of other institutions v\ ithin the Citv of Baltimore for the accomplishment 
of the teaching and training rct|uirements of the School of Medicine, except where 
sharply specialized disciplines are concentrated, is a makeshift and undesirable digres- 
sion and must be so acknowledged. 

patients' beds 
To so acknowledge the present trend is to point up the extreme need for hospital 
beds. It must be explained further that clinical material on a surgical ward differs 
radically from that on any non-surgical floor. The postoperative patient is no longer 
suitable for a wide latitude in the teaching of physical diagnosis, the demonstration of 
typical gross anatomico-pathologic findings or for the day-to-day observation of changes 
resulting from the administration of medical supportive and corrective measures. 
Surgical treatment results frequently in dramatic changes in the cause of a patient's 
disease process and a full realization of these changes must be predicated upon before- 
hand patient observation. This requirement might be described best bv stating that the 
teaching value of a patient is "used up" more readily and consistently than under a 
non-surgical discipline. Therefore, to fulfill the teaching and training requirements of 
this department, a larger patient load must be attained. 

RESIDENT STAFF 

It is lelt, generalh', that maximum teaching and training benefit, for both student 
and house officer, is reached when a suitable interval is devoted solely to the study of 
each group of patients allocated to a special discipline. Thus, each house officer and 
each student, ideally, will spend a specific amount of time on each of the several 
surgical divisions, devoting his attention completeh' to the study of patients whose 
disease is peculiar to this specialty. Such a requirement demands not only a goodly 
patient load in this specialty, but a sufficient staff of housemen to make such a rotation 
practicable and continuous. 

OUT-PATIENT DEPARTMENT 

Improvement and progress within the out-patient area has been good. There still 
exists a large deficienc) in the effectixeness and efficiency of many service areas such 
as roentgenology, laboratory, record room, and similar units. In general, the clinical 
facilities are much improved and an increased patient load is some expression of this 
improvement. It is anticipated and hoped that in the near future daily acceptance of 
patients can be made in all surgical clinic areas. The maximal efficiency of many areas, 
and the a\ailabilit\' of many others likel\ will never be achiexcd until a new physical 
plant can be built. 



DEPARTMENT OF SURGERY 215 



RESEARCH 



There is certainK' no great complacency and little pride of achievement in the 
progress made to date in the surgical research area. Little has actually been accom- 
plished—much is planned and progress is being made. Already, hovve\'er, considerable 
concern is held over space limitation. Despite the fact that the surgical floor is least in 
size, it is required that two units be given over, one to microbiology and another to 
pediatrics. Alreadv considerable resentment and friction has developed because of this 
situation. Surely a better and more agreeable solution can be advanced in the coming 
months. The addition of further projects and thus a greater load in this area will 
shordy demand some expansion in this unit. 



NON-PATIENT SPACE 

This department is severelv restricted in non-patient space. Already several members 
within the department ha\'e indicated their awareness that their productivity is to some 
degree curtailed by a lack of office and study space within the University Hospital. 
This is a most troublesome situation. These individuals carrv a good clinical load and 
much influence over students and house officers. Their visible industry in such en- 
deavors as clinical research, undertaken and pursued within this hospital, will have 
considerable influence upon student and house officer attitudes and inclinations in this 
same direction. 



Finally, this department recognizes the sincere efforts now being made to accom- 
plish the goals and ideals set forth above. It is dulv appreciative of these efforts. 



dmissions 


Patient Days 


3,272 


36,844 


866 


15,915 


252 


3,897 


168 


2,740 


821 


9,906 


134 


542 


21 


134 


27 


150 


3 


15 


14 


142 


3,576 


56,267 


445 


19,600 


742 


12,802 


3,531 


17,632 


3,896 


15,437 


1,260 


8,637 



216 bulletin: of the school of medicine, IJ. OF MD. 

UNIVERSITY HOSPITAL 
ADMISSIONS AND PATIENT DAYS 

Fiscal Year 1956-1957 

A 

General Surgery 

Neurosurgcr\' 

Orthopedics 

Thoracic Surger\- 

Urology 

Ear, Nose, Throat 

Opthalmologv 

Oral Surgerv 

Proctology 

Plastic Surgery 

^Medicine 

Psychiatry 

Pediatrics 

Newborn 

Obstetrics 

Gynecology 

19,028 200,660 

* Includes Neurology, Dermatology, Infectious Diseases, Hematology. 

UNIVERSITY HOSPITAL 

Baltimore 1, Maryland 

SURGICAL OPERATIONS 

Fiscal Year 1956-57 

July 585 

August 626 

September 516 

October 560 

November 564 

December 430 

January 566 

February 514 

March '. 562 

April 563 

May 562 

June 482 

TOTAL OPERATIONS .... 6,530 

TOTAL LIVE BIRTHS 3,653 

TOTAL AUTOPSIES 391 

AUTOPSY PERCENTAGE 48.8% 



UNIVERSITY HOSPITAL 217 

UNIVERSITY HOSPITAL 
OUT-PATIENT DEPARTMENT 

Total patient visits for 
Department fiscal year 1956-1957 

Medicine 

General 13,347 

Allergy 3,703 

Arthritis 1,009 

Cardiology 1,302 

Chest 818 

Dermatology 7,798 

Dept. "S" 2,068 

Diabetic 1,770 

Endocrinology 266 

Hematology 653 

Gastro-Intestinal 719 

Hypertensive 203 

Isotope 557 

Neurology 1,317 

Demvelinating 21 

TOTAL-Medicine 35,551 

Obstetrics 16,393 

TOTAL-Obstetrics 16,393 

GynecoJogy 

' General 7,864 

Oncology 895 

TOTAL-Gynecology 8,759 

Pediatrics 

General 15,701 

Pediatric-Cardiology 513 

Pediatric-Chest 127 

Pediatric-Ilematologv 12 

Pediatric-Seizure 793 

TOTAL-Pediatrics 17,146 

Siirgerr 

General 14,292 

ENT 1,478 

Genito-Urinarv 3,521 

Neiiro-Surgerv 767 

Orthopedics 3,476 

TOTAL-Surgery .7.77 23,534 

Dental 3,706 

TOTAL-Dental .777." 3,706 



218 



BULLETIN OP THE SCHOOL OF MEDICINE, U. OF AID. 



1 otal patient visits for 
Department fiscal year 1956-1957 

Child Guidance 1,389 

TOTAL-Chiia Ckiiclancc 1389 

Medical Comprehensive 1,483 

TOTAL-Medical Comprehensive 1,483 

Physical Therapy 5,108 

TOTAL-Physical Therapy 5,108 

] lome Visits 559 559 

Psychiatry 7,036 7,036 

Psychiatry Child Guidance 2,286 2,286 

W'ell Baby CHnic 5,444 5,444 

GRAND TOTAL 128,194 

Laboratory Examinations 68,643 

X-Ray Examinations 11 ,424 

Clinic visits by race- 
Colored 105,363 

White 23,031 

UNIVERSITY 1 lOSPlTAL 
Baltimore 1, Maryland 

OUT-PATIENT DEPARTMENT CLINIC VISITS 

Fiscal Year 1956-57 
New 

July 1,692 

August 1 ,762 

September 1,384 

October 1,822 

November 1,630 

December 1,260 

January 1,705 

February 1,439 

March 1,668 

April 1,512 

May 1,632 

June 1,329 

TOTAL 18,835 

GRAND TOTAL 128,394 



Revisits 


Referrals 


8,287 


675 


8,928 


576 


7,467 


358 


9,255 


614 


8,828 


584 


7,357 


422 


8,597 


588 


8,359 


611 


9,144 


650 


9,432 


624 


9,079 


749 


7,867 


508 



102,600 



6,959 



UNIVERSITY HOSPITAL 219 

UNIVERSITY HOSPITAL EMERGENCY ROOM 

Total patients treated 37,240 

UNIVERSITY HOSPITAL 
INTERNS AND RESIDENTS 

Fiscal Year 1956-57 

DcpartniciU Total 

Intern— Rotating 23 

Intern— Medicine 5 

Intern— Pediatrics 3 

Intern— Dental 3 

Anesthesia 8 

Dental 1 

Medicine 22 

Obstetrics-Gynecology 14 

Pediatrics 8 

Psychiatry 18 

Radiology 7 

Surgery 35 

TOTAL 77 147=^ 

* The above total includes Fellows, and members of the House StafF paid from Departmental 
Restricted Funds, or other Funds. 

UNIVERSITY HOSPITAL 
Baltimore 1, Maryland 

VOLUNTEER SERVICES 

Fiscal Year 1956-57 

Hours 
Volunteers Contributed Service 

Hed Cross Prodiictio)! Workers 3,892 278,318 Surgical Dressings 

860O.R. and Delivery Caps 

Red Cross— Nitrse's Aides 5,089 Patient care on Wards 

Wome}i's Auxiliary Board Volunteers 6,646 Information Desk, Out-Patient 

Department, Patient's 
l.ihrarv, etc. 

High School Student Vohinteers 718 Patient care on W^ards 

Total Hours Contributed 16,345 



220 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 



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UNIVERSITY HOSPITAL 221 

UNIVERSITY HOSPITAL 

Fiscal Year 1956-57 

COST PER PATIENT DAY 

The following information cleri\'ed from 

"Hospital Statements of Reimbursable Costs submitted to the Maryland Hospital 

Service (Blue Cross). 

Period July 1, 1956 through June 30, 1957 

^Adjusted In-Patient Days 214,483 

Total Operating Expenses $6,302,357.33 

Operating Expenses including Depreciation $6,680,498.77 

Blue Cross Per Diem Cost. $31.15 

Weighed by Out-Patient visits— 5 visits equal 1 patient day. 



\ 



MEDICAL SCHOOL SICCTION 

STUDENT ORIENTATION PROGRAM SUCCESSFUL 

Largely because of llic efTorls of the Dean's oflit e and llie Student Government 
Association of the Sc liool of Medicine, an Orientation I'rof^rani for new students was 
introduced at the l)eginning of the Sescjuicentennial Year. 

'I'iie |)n)j^ram o|)cncd on Monday, Septeml)er 17 with an achlress l)y Mr. Howard 
Siegel, Ciiairnian of the Student Orientation Committee. A wehome was given by 
Dean Stone. Addresses by Drs. Louis Krause and Rol)ert Parker concerning the 
future of the sludcnl in medicine and the medical school curriculum were then given. 
Dr. l)ietri( h C. Smith discussed the organization of the University. 

In order, the following Medical School Organizations were then i)resented: Library. 
Student Health Ser\i( c. Alpha Omega Alpha, Student Government Association. 
Student American Medical Association, Interfraternity Council, Newman Club, 
Christian Medical Association and the year book. Terra Mariae Medicus. Later in 
the day students were addressed by Drs. Mauric e IMncoffs and John C. Krantz, Jr. 

On 'l\iesday there were additional lectures and demonstrations designed to further 
orient the students. A tour of the medical school was also conducted and followed Ijy 
a luncheon sponsored by the Medical Ahnnni Association held in the 'I'errace Room 
of the Psychiatric Institute. 

On Wednesday additional addresses designed to further orient the students, were 
given by Drs. I'incoffs and Woodward. At this time various instrument companies, 
panic ularly |)urvey()rs of microscopes demonstrated their instruments. 

At 2 I'.M. a convocation was held for all students and faculty in the Westminster 
Presbyterian Church, (ireeneand Fayette Streets. 

The program was opened by Dean Stone who presented the distinguished guests 
and memi)ers of the lioard of Regents. Dr. Wilson H. Flkins, President of the Uni- 
versity, gave the ()|)ening address which was followed by a brief yet forceful address 
by Mis E.xcellency, 'I'he Governor of theStateof Maryland, i'heodore R. McKeldin 
(see i)elow). 

'I'he convocation e.xercises were concluded with a lea and rece|)tion s])onsorecl by 
the Women's l^oard of the University Hospital and held in the 1()4th Medical Bat- 
talion Armory adjac cni to Westminster Churc li. 

'I'he convocation marking the beginning of the Sesc|uicentennial Year is j)lanned 
as an ammal feature of the orientation program marking the beginning of each 
si hool year. 

.\DDki:ss Hv (i()\i':k\()R riii'.oDoKi-, k. .McKIILDIN 

The urge to advance I he sciences ol medicine and surgery grows naturall\' with 
the |)r()gress of civilization, i'he earliest prehistoric men, we are led to believe, lived 
in constant suspicion ol each other. .Medicine was unknown, and the best known 
surgery for the prolonging ol lile was the skillful ai)i)lic ation of a c rude clul) on the 
skull of an inlniding neighbor. It was only when tribes at last weri' formed for com- 

i 



ii BULLETIX OF rilE SCHOOL OF MEDICINE, U. OF MD. 

panionship and nuitual protection ihat the life of one man became important to 
another. 

Today we scoff at the dubious arts of tlie witch doctor, but although we know his 
wizardry effected no true cures, we must at least give him credit for being an impor- 
tant factor in the awakening within the people realization of the need for some effort 
to cure sickness and prevent the spread of disease. Somewhere along the line, a witch 
doctor with more intelligence than his fellow practitioners discovered the curing or 
alleviating powers in some woodland herb or group of herbs and proclaimed this new 
knowledge a part of his magic. Others went along with the trend and medicine was 
on its way. 

It was a long way from those primitive eons to this day — and a long way still 
stretches ahead. I beUeve that today, despite the continuing threats of war and the 
development of weapons of wholesale destruction, civilization is approaching a new 
plateau in its long march forward. It is significant that the heads of nations of most 
bitter rivalry are more willing to sit in conference with each other. It is significant 
that international upheavals, which once would have brought quick resort to arms, 
now are accompanied by no blasting guns or bursting bombs. There is great signifi- 
cance, too, in the fact that once the power of the atom was clearly defined in its 
death-dealing blow over Japan, it was the men and women of the medical sciences 
who moved with the greatest alacrity to apply this power — not to the dealing of 
death — but to the prolonging of life — not just for friendly countries, but for all man- 
kind. 

Yes, we have come a long way in medicine and surgery — a long way in the pre- 
vention of disease and the curing of human ills. I feel that we have come a long way 
too toward that goal of human brotherhood — the best in civiUzation. And, yes, there 
is a long way yet to go — but we are on our way, and among the leaders now, as always, 
are the physicians and surgeons, and the nurses and druggists, and all who are allied 
with them in the arts of human betterment. 

I greet you with real pleasure on this anniversary opening of your school year — not 
as just another group of much needed future physicians and surgeons — but as leaders 
in the steady march toward that brighter, distant day when ancient hatreds will be 
banished from the hearts of men and the real value of the human family will be recog- 
nized universally as it historically has been recognized in the credo of medicine. 

DR. SPENCER NAMED EMERITUS PROFESSOR 

Upon nomination of the faculty and by confirmation of the Board of Regents of 
the University, Dr. Hugh R. Spencer who retired as Professor of Pathology in the 
School of Medicine, was recently named Emeritus Professor of Pathology. 

SCHEDULE FOR "MAN AND HIS ENVIRONMENT" COURSE SET FOR 

REMAINDER OF YEAR 

The following schedule includes the speakers for the orientation course "Man 
and His Environment" beginning with the February 2nd lecture and continuing 
through April 13. The last three lectures have not been assigned at the time the 
Bulletin goes to press. 



MEDICAL SCHOOL SECTION iii 

Chemical Hall, Saturdays, 9:00-11:00 A. M. 

February 2 Medicine in Pre-History and Primitive Peoples 

Speaker: Richard H. Shryock, The WilHam H. Welsh Professor 
of ihe History of Medicine, Johns Hopkins University. 
February 9 ^ledicine of the People of Israel 

Speaker: Louis A. M. Krause, Professor of Clinical Medicine, 
University of Maryland. 
February 16 Greco-Roman Medicine 

Speaker: Raymond 'Si. Burgison, Assistant Professor of Pharma- 
cology, University of Maryland. 
February 2,^ Arabian Medicine 

Speaker: Louis A. ]\L Krause, Professor of Clinical Medicine, 
Liniversity of jNIaryland. 
March 2 Renaissance ^ledicine 

Speaker: Louis A. M. Krause, Professor of Clinical Medicine, 
L^niversity of ^Maryland. 
March 9 Patterns in Disease 

Speakers: Theodore E. Woodward, Professor of Medicine and Head, 
Department of Medicine, LTniversity of Maryland. 
Ephraim T. Lisansky, Associate Professor of ^ledicine, 
Associate in Psychiatry, University of Maryland. 
March 16 Patterns in Disease 

Speakers: Doctors Woodward and Lisansky. 
March 23 Population Pressures 

Speaker: Robert Carter Cook, Professorial Lecturer in Medicinal 
Genetics, George Washington University School of 
Medicine. Lecturer in Biology, George Washington 
Ll'niversity. Director, Population Reference Bureau and 
Associate of Research in Human Heredity, Washington 
D. C. 
March 30 Aging Population 

Speaker: Nathan W. Shock, Chief, Section on Gerontology, 
Baltimore City Hospitals (USPHS). 
April 6 Philosophy of Science 

Speaker: Thelma Z. Lavine, Assistant Professor in Philosophy, 
University of Maryland. 
April 13 Juvenile Delin(|uenc}' 

Speaker: Peter P. Lejins, Professor of Sociology, University of 
Maryland. 



PROFESSOR FIGGE XAMED AMERICAN CANCER SO(TETY HEAD 

Dr. Frank H. J. Figge, Professor of Anatomy, has been recently elected President 
of the Maryland Division of the American Cancer Society. Dr. Figge, who has for 
many years served as Vice-President of the Maryland Division, was elected to suc- 
ceed Dr. C. Bernard Brack, who became Chairman of the Board. 



iv BULLETIN OF TUE SCHOOL OF MEDICINE, U. OF MD. 

DR. GOLDSTEIN RESIGNS PATHOLOGY POST 

Dr. Albert E. Cioklslein, for many years Assistant Professor of Pathology in the 
School of Medicine and active in the teaching of genito-urinary pathology, tendered 
his resignation effective with the beginning of the new school year. The School of 
Medicine acknowledges the long and faithful service of Dr. Goldstein and commends 
him for the line work he did in teaching genito-urinary pathology. 

In his letter to Dr. Wagner, Dr. Goldstein ("Goldie" to many faculty members 
and former students) stated, "I want you to know that I have spent my most pleas- 
ant days with the students at the University of Maryland as well as with all the men 
in the Department of Pathology. I have always been keenly interested and still am 
interested. However, I feel that I now need a little rest. 

"While I do not intend to dissociate myself entirely, please feel that if I can be 
of service to you and certainly to the University of INIaryland whether it is the 
Medical School or otherwise, I shall always be happy to do so. 

"I have obtained much knowledge at the University of Maryland during the past 
35 years and I appreciate it." 

ANNOUNCEMENT 

Next Congress, Pan American jMedical Association 
TO Be Held in IVIexico City 

The next and 10th Inter- American Congress of the Pan American Medical Asso- 
ciation will be held in Mexico City, the scientific sessions beginning on Monday, 
November 18-22, 1957. 

MARYLAND SOCIETY FOR :\IEDICAL RESEARCH OFFERS NEW FIL:\I 

A much needed want has been tilled with the production and release of a motion 
picture entitled "Handling Laboratory Animals." Prepared at the National Institute 
for Medical Research in England, the tilm runs for about 18 minutes and demon- 
strates how all of the common laboratory animals should be handled to eliminate 
discomfort and fear and to achieve the maximum of cooperation during experimental 
procedures. The film is accompanied by a sound tract. It may be obtained through 
the local office of the Maryland Society for Medical Research ^ Dr. Dietrich (\ 
Smith, Secretary. 

f^ORMER RESIDENT OPENS PRACTICE 

Dr. Henry E. Langenfelder, until recently resident in surgery at the University 
Hospital, has announced the opening of his office for the practice of general surgery 
at 104 West Madison Street in Baltimore. 

MERCY HOSPITAL NEWS 

NEW HOSPITAL BUILDING PLANS 

While detailed plans and specifications are not yet available. Sister Mary Thomas, 
R.S.M., Administrator, reports progress in the initial development of the structure 
to be erected on St. Paul Place between Saratoga and Pleasant Streets. 



MEDICAL SCHOOL SECTION v 

Dr. J. J. Rourke, nalionally recognized consultant iii the field of hospital con- 
struction, has been retained to determine just what facilities must be included in the 
new construction to best serve the over-all hospital needs of the community. Dr. 
Rourke is })resently conferring with professional and non-professional StafT members 
in an efTort to determine how best the new Mercy Hospital can help solve the two 
most pressing hospital problems — ^the tremendous shortage of hospital facilities and 
the advanced age of most existing hospital plants that serve iNIetropolitan Baltimore. 

Working closely with Dr. Rourke is the Baltimore architectural firm of Taylor and 
Fisher, and their associate. Air. Helge Westerman of New York City, a nationally 
recognized specialist in the field of hospital architecture. It is the task of this group 
to formulate actual construction {)lans and to supervise the erection of the new hos- 
pital. 

AIERCY HOUSE STAFF NEWS 

Doctor Fernando Alonso-Lei, Associate Resident in Surgery came to Mercy after 
completing three years of Residency in Surgery at the Baltimore City Hospital. 

Doctor Alonso is actively interested in Cardio-vascular Surgery and spends a 
great deal of his time in the "dog laboratory" at Mercy in e.xperimental work. 

FORMER MEMBERS OF THE MERCY HOSPITAL HOUSE STAFF RETURN 

Doctor Joseph T. Alichels and Doctor Donald S. Carter, former members of the 
Mercy Hospital House Staff, who have spent the past two years in the Armed Forces, 
will return to Mercy on November 1, 1956. They will be Senior Assistant Resident in 
Gynecology and Obstetrics and Resident in Otolaryngology, respectively. 

NEW MEMBER OF VISITING STAFF 

Doctor Frank Kuehn, former Resident in Aledicine (1955-56) has recently been 
appointed to the X'isiting Staff at Mercy. 




Equipment ana Supplies for: 

PLysicians and Surgeons * Hospitals 

Laboratories * Inaustrial Clinics 

ATurray-jBaumgartner 

BH^^BIi SURGICAL INSTRUMENT COMPANY, INC. 

5 West CKase Street • SArato^a 7-7333 
Baltimore 1, Maryland 




ABSTRACTS 

IIi;m()1)v\.\mic Ai.ikkatiuns in iiKMoRKiiAdic I'KVKK.* liy George EiUwisle, .M.D., 

Assistant Professor of Medicine, Department of Medicine, University of Maryland, 

and Kdward Hale, M.I)., Chief of Medicine, V.A. Hos[)ital, Leech I'arm Road, 

Pittsburgh, Pennsylvania. 

A hemodynamic study was done on ,U patients during the various stages of hennjr- 
rhagic fever. In the initial febrile phase some increase in cardiac outjjut was noted, 
especially in patients with high fever. During the subsequent shock or hy|)olensive 
phase, striking reductions in cardiac outjjut were seen associated in most patients 
with warm dry extremities and mild hemoconcent ration. A minority of patients 
presented low cardiac outputs associated with a high i)eripheral resistance and 
moderate to marked hemoconcentration. The latter group responded well to treat- 
ment with intravenous human serum albumin and showed a rise in cardiac output. 
The former group was treated with nor-epinephrine and the resulting rise in mean 
arterial pressure was caused by increased perijjheral resistance. 

Twenty studies were ])erformed during the hypertensive i)hase of hemorrhagic 
fever. Patients were divided into two groups according to the presence or absence of 
diuresis. When a hypertensive patient was also oilguric, high cardiac output was 
frequently found and it was associated with a normal or slightly elevated j)erij)heral 
resistance. Hypertensive i)atients who had begun their diuresis had normal cardiac 
out[)uts and significantly elevated j)eripheral resistance. 

Some of the patients during the hypertensive phase presented the clinical syn- 
drome of "Relative-Hypervolemia" described by I'^arle. As a group these patients 
were oliguric, had high cardiac outputs with normal to low i)eri{)heral resistance and 
had higher blood volumes than the hypertensive patients not presenting this syn- 
drome. Metabolic- acidosis was common in this group. 

Pulmonary edema, an infrecjucnt but usually fatal complication of hemorrhagic 
fever, responded to therapy if the patients were also hyi)ertensive at the time of 
pulmonary edema, but this complication was uniformly fatal in patients who were 
norniotensive or hypotensive at the lime edema developed. 

Transient Ventricular Tachycardia I-'oij.owinc; tiik X'ai.sai a a .M \.\i;r\ kr 
IN A Patient with Paroxysmal Atrial Tac ii\(ARi)iA.t \iy W . Hollander, .M.D., 
Instructor in Medicine, Evans Memorial llosi)ital, l)ei)artment of Medicine, 
Boston School of Medicine, and (leorge Kntwisle, M.l)., Assistant Professor of 
Medicine, Department of Medic ine, I'niversity of Maryland. 

Transient ventricular arrhythmias have occurred during s])ontaneous reversion of 
paroxysmal auricular tachycardia and have also been described following various 
maneuvers used to convert ])aroxysmal atrial tachycardia such as carotid sinus 

* Accepted for publication in the journal Circulalimi. 

This project was performed under the au.spices of the Hemorrhagic Fever Commission, Armed 
Forces Kjiidemiologica! Hoard, Walter Keed Army Medical Center, Washington 12, I). ('. 
t Accepted for publication in \\\v Amrricnn llrarl Joiirnal. 



AHSTNACTS vii 

stinuihuioii, (xular picssuic, huh liolyl and lu-osli^^niiiu'. Of tlu'sr lallcr nuihods, 
(lircii or indirort vagal slinuilalion is loiiinion to all, and may have been the basis 
for the (k'V(.'l()|)iiK'nt of transient ventricular tachycardia recorded during the \'alsalva 
maneuver in the i)atienL described. However, since this ventricular arrhythmia 
occurred during the \'alsalva maneuver, the combination of adrenergii stimulation 
and myocardial ischemia could atcounL for the arrhythmia. 

Urinary Excri;tion of S-IIvdroxvindoiJ': Aci/ru: Acid, A Siiuotonin Mktaho- 
i.iTK, IN 1Iyi>i;rtknsivi'. Ri:nai.-Vascui.ar I)isi;asi;.* liy I-'ramis ). Horges, M.I)., 
Associate in Medicine, Division of Hypertension, Departnu-nt of Medicine, 
University of Maryland, and Samuel P. Hessman, M.D., Associate i'rofessor of 
Pediatrics, l)e])artment of I'ediatrics, University of Maryland. 
The urinary excretion of 5-hyclroxyindole acetic acid in () patients with malignant 
hypertension and 2 patients with chronic glomerular nephritis is reported. Low levels 
were recorded for ,^ patients exhibiting the malignant [)hase of hyi)ertensive cardio- 
vascular disease and both patients with chronic glomerular nephritis. All patients 
exhibited extensive renal involvement and 5 of the 6 i)atients with malignant hyper- 
tension had severe arterial lesions. 'I'he 2 i)atients with carcinoid tumors did not 
cxhil)it abnormal urinary 5-hy(lroxyindole acetic acid levels. Data are presented 
which show that proteinuria does not interfere with the estimation of 5IH.\A in the 
urine. 

Intr.\-Atriai- Block. t By Samuel M. liradley, M.D., Assistant Resident in Medicine, 
Mercy Hosjjital, Baltimore, and Henry J. 1>. Marriott, M.A., B.M. (Oxon) Asso- 
ciate Professor of Medicine, University of Maryland School of Medicine; Chief, 
Electrocardiograph Department, Mercy Hospital, Baltimore. 
Attention is drawn to differences of opinion regarding the upi)er normal limit of P 
wave duration and the delinition of intra-atrial block. There seems to be good reason 
for accepting O.U second as the upper limit of normal and a P wave duration of 0.12 
second or more as indicative of intra-atrial block. By this criterion 4.5 per cent of 
4500 consecutive electrocardiograms taken in a general hospital showed intra-atrial 
block, an incidence almost as great as that of atrioventricular or intraventricular 
bloc k in the same series. 

* Siil)millc'cl lo lliL- l'i(H'i'(.'clin;^s ol" the Socicl}' for l';x|)i'iiiiu'ntal I5ii)Ioj;y and Mi-cliciiic. 
'Pile authors wisli to ackiiowii-df^c witli apprccialioii the trchiiical assistance of Miss Aiine Rider. 
This study was supported in part l)y the Hypertensive I-'ouiidatioii, Inc., Baltimore, Maryland 
and Me(?ormick & Coni|)any, Baltimore, Maryland. 

t This manuscript has i)een accepted for pui)lication hy Circiihitivn. 



POST GRADUATE COMMITTEE SECTION 

POST GRADUATE COMMITTEE, SCHOOL OF MEDICINE 



HOWARD M. BUBERT, M.D., Chairman and Director 
Elizabeth Carroll, Executive Secretary 

Post Graduate Office: Room 201 

Old Medical Building, Lombard and Greene Streets 

Baltimore 1, Maryland 



BASIC SCIENCES 

We are happy to announce that the Postgraduate course Basic Sciences As They 
Apply to the Practice of Medicine is to begin on January 9 and end on May 29. Classes 
will be held on Wednesday afternoons 4-6 P3I. Tuition is $50.00. For further infor- 
mation please contact the Postgraduate Committee office. 

SURGICAL ANATOMY 

The Postgraduate course in Surgical Anatomy will begin on January 28 and end 
on June 8. Classes will be held on ^Mondays from 2-5 P.^L and on Wednesdays from 
10 A.]\I.-1 P.^I. Tuition is S150.00. Because enrollment is limited, those physicians 
interested in taking the course should contact the Postgraduate office without delay. 

"CALENDAR" 

The Committee would appreciate your comments on the CALENDAR OF 
E\'ENTS, the publication which is sent from the Postgraduate Committee office 
weekly in an effort to keep you abreast of medical teaching on the campus. 

TV-]\ID 

The Sunday afternoon television presentation T\'-MD over WBAL-T\', Channel 
11, now in its sixth consecutive year, has as its theme for the current series "Then 
and Now" in keeping with this, the Sesquicentennial year of the Medical School. 
The Committee is grateful to all those of our faculty who are giving so generously of 
their time in the production of these programs. 



ALUMNI ASSOCIATION SECTION 

OFFICERS* 

J. Sheldon Eastland, M.D., President 
William B. Long, M.D., F>resident-elect 

Vice-Presidents 

A. Harry Finkelstein, M.D. Arthur Siwinski, M.D. Martin Strobel, M.D. 

Edwin H. Stewart, Jr., M.T)., Secretary Ernest I. CoRNBROf)KS, Jr., M.D., Treasurer 

J. Emmett Quekn, M.D., Assistant Secretary Minette E. Scott, Executive Secretary 

William H. Triplett, M.D., Director 



Board of Directors 
J. Morris Reese, M.O., 

Chairman 
J. Sheldon Eastland, M.D. 
Ernest I. Cornbrooks, Jr., M.D. 
Edwin H. Stewart, Jr., M.D 
Simon Brager, M.D. 
Frank N. Ogden, M.D. 
H. Boyd Wylie, M.D. 
J. Emmett Queen, M.D. 
Gibson J. Wells, M.D. 
William H. Triplett, M.D. 
William B. Long, ^LD. 



Nominating Committee 
Emanuel Schimunek, M.D., 
Chairman 
Dexter L. Reimann, M.D. 
Edwin S. Muller, M.D. 
J. Howard Franz, M.D. 
Howard B. Mays, M.D. 



Representatives to General 
Alumni Board 
William H. Triplett, M.D. 
Thurston R. Adams, M.D. 
Daniel J. Pessagno, M.D. 



Library Committee 
Milton S. Sacks, M.D. 

Representatives, Editorial Board. 

Bulletin 

Harry C. Hull, M.D. 

Albert E. Goldstein, M.D. 

J. Sheldon Eastland, M.D. 

(ex-officio) 

Representatives, Advisory Board, 

Faculty 

William H. Triplett, M.D. 

Albert E. Goldstein, M.D. 

Edwin H. Stewart, M.D. 



DEAN'S LETTER 



Dear Members of the Alumni: 



The Medical School is attempting to increase the interest of the Alumni in its 
educational program. Approximately one year from now, we are initiating annual 
reports and we hope that we will be able to make it available to you for 1956-57. 
The report will contain definitive information on the faculty, students, educational 
program, research studies completed and in progress, and campus improvement in 
physical facilities. 

In addition, where it is possible, members of the Medical School administration 
and faculty are attempting to attend gatherings of alumni at scientitic and clinical 
professional sessions and annual meetings. Through this type of personal contact, 
we hope to be able to answer many of your Cjuestions and establish rai)port that 
will be beneficial to the Alumni and to the Medical School. During the current school 
year the Dean has aciomjianied Dr. William H. Triplett, Director of the -Medical 
Alumni Association to the Xorth Carolina State Medical Society Meeting at Pine- 
hurst. Through the good efforts of Dr. and Mrs. J. B. Anderson of Asheville, a delight- 
ful luncheon was held for him by Xorih Carolina University of Maryland Alumni 
and their wives. 

Again at the annual meeting of the West Virginia Stale Medical Association at 
White Sulphur Springs, August 23-25, Dr. Triplett and the Dean had the ])leasure 



X BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

of meeting with the Maryland Alumni and wives at a cocktail party arranged by Dr. 
William D. INIcClung and Dr. James A. McClung for the evening of August 23rd. 

The wonderful hospitality and interest in the Medical School by the Alumni of 
West Virginia and North Carolina are adding greatly to the good fellowship develop- 
ing among the Alumni of the University of Maryland, School of Medicine. 

We hope that all of you will take every opportunity to visit the School in person, 
and that we will have the pleasure of showing you the educational program and 
research being done at Lombard and Greene Streets in Baltimore. 

William S. Stone, M.D. 

Dean 

DR. CHARLES REID EDWARDS NOMINATED RECIPIENT OF 1957 

HONOR AWARD 




Dr. C. R. Edwards 



To Receive Honor on Occasion of Sesquicentennial Alumni Celebration, 

June 6, 1957 

Dr. Charles Reid Edwards, for many years Professor of Surgery in the School of 
Medicine and active on the staff of University Hospital as a Clinical Surgeon, has 
been nominated recipient of the Medical Alumni Association's 1957 Honor Award 
and gold key. 

This award established in 1948 for "outstanding contributions to medicine and 
distinguished service to mankind" is presented annually to an alumnus who has 
earned this honor through outstanding achievements as required for the nomination. 

A native of Medley, West Virginia, Dr. Edwards attended the Adamstown School 
in Frederick County, Maryland and was graduated from the School of Medicine, 



ALUMNI ASSOCIATIOX SECTION xi 

University of Maryland in 1913. Following an internship at the University hospital 
he became an assistant in orthopedic surgery serving until 1916 when he went on 
active duty with the Army of the United States with the rank of 1st Lieutenant in 
the Medical Corps, being promoted ultimately to Captain. 

Upon his return from service, he was appointed to the staff of the University 
Hospital serving as assistant in surgery and subsequently was promoted in 1929 to 
Professor of Clinical Surgery. With the retirement of Dr. Arthur M. Shipley, Dr. 
Edwards assumed the professorship and ably conducted the department until the 
appointment of his successor Dr. Robert Bu.xton who now serves as Departmental 
Chairman and Professor. 

Long interested in chnical surgery, Dr. Edwards has earned the deepest respect 
and admiration of his fellow colleagues and practitioners. 

He is a member of the Medical and Chirurgical Faculty, the American Medical 
Association, the Southern Medical Association, the American College of Surgeons, 
the Southern Surgical Association, the Clinical Surgical Society, The American 
Society for the Surgery of Trauma and the American Surgical Association. He is a 
member of the Xu Sigma Xu fraternity. 

For many years, Dr. Edwards has loyally supported the cause of the School of 
Medicine and following World War H was largely instrumental in taking the cause 
of the University before the Board of Regents and the Legislature which resulted in 
the initial phase of the development of the School of Medicine. For a number of 
years he has been active on the Board of Directors of the ^ledical Alumni Association. 
He has been a member of a number of ^Medical School committees and to the younger 
faculty has been a reliable source of tempering influence and advice. As one alumnus 
has simply stated, "A finer man, a finer doctor and a finer example of patient wisdom 
one could never know." 

FIFTY YEAR VETERAXS TO BE FETED 

The Medical Alumni Association is already laying active plans for a celebration on 
June 6, 1957 in honor of the class of 1907. Members of the Golden Anniversary 
classes of the 3 schools will be honored at the Sesquicentennial celebration marking 
Alumni and Commencement week. Listed below are the known members of the class 
of 1907 graduated on the occasion of the Centennial of the School of Medicine and 
who no doubt will return to receive the 50 year honor certificate on the occasion of the 
Sescjuicentennial celebration in June. 

C;()LDEX AXXRERSARY CLASSES 

1907-1957 

(Centennial Class) 

Iniversily of Maryland 

Otho P. Argabrite Julius E. Cross John Burr Piggoti 

James H. Bates Joseph L Kemler Harry Y. Righton 

Jacob W. Bird Arthur E. Landers Herbert Schoenrich 

James S. Fox Thomas H. Legg Charles I. Shaffer 

Walter C. Gordon James E. Mann 



BULLETIN OF THE SCHOOL OF MEDICINE, U OF MD. 



Elmer J. Beaulieu 
Napoleon Bisson 
]\Ierritt Brice 
Doniinick Di Pasca 
William Fessler 
Adolph Flachs 
Leo L. Gardner 
Louis L. Hoff 
Howard T. Horsley 



Ballimore Medical College 

Ezra A. Jones 
Frank V.Langfitt 
Clarence V. Langfitl 
Jacob L. Malhesheimer 
Peter C. Mikkelsen 
James J. O'Connor 
Benjamin Parvey 
Albert E. Perron 



Herman Paul Rieger 
Weaver B. Rogers 
Otto W. Scholpp 
I'Vank J. Schwartz 
Philip J. Spaeder 
Fred E. Steele, Jr. 
William J. V. Taylor 
Charles Vincent, Jr. 



College of Physicians and Surgeons 



Walter A. Carr 
Walter W. Columbus 
James J. Donohue 
Edward H. Freeman 
Earl F. Glass 
Michael J. Griffin 
Arthur W. Higgins 



Frederick C. Lamar 
T. Frederick Leitz 
Frederick L. ^NIcLeod 
Joseph C. Peck 
Ernest M. Perry 
Jesse A. Powell 



Desausser G. Preston 
Earl L. Reger 
Edward E. Rose 
William J. Schmitz 
Edmond D. Tucker 
John I. Wiseman 



ALUMXI ASSOCL\TION TO SPONSOR COCKTAIL PARTY AT AMERICAN 
MEDICAL ASSOCIATION MEETING 

Reception to Be Held on Evening of June 5, 1957 

The ]\Iedical Alumni Association has announced the formation of a committee 
which will arrange and conduct a cocktail party for University of Maryland alumni 
and their ladies on the occasion of the annual meeting of the American Medical 
Association which will be held in New York City June 3-7, 1957. 

Dr. Joseph Nataro, 172 Littleton Avenue, Newark 3, New Jersey is Chairman of a 
committee which has already arranged for the party to be held in the air-conditioned 
cocktail lounge in the New York Coliseum on the evening of Wednesday, June 5, 
1957 from 5 to 7 P.M. 

While preliminary arrangements are now in progress and while further details of 
this party will be carried in the April, 1957 issue of the Bulletin, all interested are 
urged to inquire further of the ^ledical Alumni Association or through Dr. Nataro. 

The Association sincerely hopes that this affair can be included as one of the more 
important functions of the Alumni Association during the Sescjuicentennial year. 



ALUMNI ASSOCIATION SECTION 



NOTICE 

COMMEMORATIVE SESQUICENTENNIAL ITEMS ON SALE BY WOMEN'S 

Al^XTLTARY BOARD 




The Women's Auxiliary Board 
of the University Hospital in 
honor of the Sesciuicentennial 
Year presents a commemorative 
cup and saucer and ash tray for 
sale. Each piece will carry the 
inscription "150 years of Medical 
Education" together with the 
seal of the University. These 
items will be on sale during the 
Sesquicentennial Year in the Gift 
Shop of the University Hospital. 
They may be obtained either by 
phone order or by letter. Prices 
are available upon in(|uiry. 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF AID. 
OBTAIN YOUR COMMEMORATIVE MEDAL NOW 




As announced in a previous number of the Bulletin, the Medical Alumni Associa- 
tion is sponsoring a Commemorative Medal to be placed on sale during the month 
of January. The medal illustrated herewith will be struck principally in bronze but 
a limited addition of silver coins will be available, these being the first to be struck. 

The price of the silver medal will be $6.00 postpaid and for the bronze $3.00. 
Orders should be sent to the Medical Alumni Association, University of Maryland, 
Lombard and Greene Streets, Baltimore 1, Maryland accompanied by remittance. 
Medals will be forwarded shortly after the issue date which is expected to be Janu- 
ary 20, 1957. 

DR. NEAFIE HONORED 

Dr. Charles A. Neafie, class of 1909, and a resident of Pontiac, ^Michigan, was the 
recipient of the 7th annual award of the Oakland County Medical Society for "dis- 
tinguished service to medicine." 

ite:\[S 

Recent publications by Dr. Samuel L. Fox of the class of 1938 include "Nasal 
Polyps in Relation to Nasal Sinusitis" (Eye, Ear, Nose and Throat Monthly 35: 
492-496 August 1956) and "Vasomotor Rhinitis in Hypertension" (Maryland State 
Medical Journal \'olume 5, Number 3, March 1956). 

Dr. Jacob H. Conn, class of 1929, has been invited to become a member of the 
Editorial Board of the Publication Society of the Institute of Research in Hypnosis. 
Dr. Conn is a member of the Editorial Boards of The Journal of Clinical and Experi- 
mental Psychopathology, The Nervous Child, The Archives of Criminal Psycho- 
dynamics, The Journal of Clinical and Experimental Hypnosis, and Tice's System 
of Medicine. Dr. Conn lectured on "The History of Hypnosis" in October 1956 in 
New York during the Workshop on Hypnosis which is under the auspices of the Long 
Island University and the Society for Clinical and Experimental Hypnosis. 



ALUMNI ASSOCIATION SECTION xv 

Dr. Lorman L. Hoopes, class of 1941 and a Diplomate of The American Board of 
Obstetrics and Gynecology, has been elected a Qualified Fellow of The International 
College of Surgeons, Section of Obstetrics and Gynecology. 

Dr. Ira C. Long, class of 1923, has retired as Superintendent of the State Hospital 
at Goldsboro, North Carolina after having served on the stafif of that hospital for 20 
years, the last 11 years as Superintendent. Dr. Long now resides in Bonham Heights, 
Morehead City, North (\irolina. 

Dr. John F. Strahan, class of 1949, having completed his residency in dermatology, 
has passed the American Board of Dermatology and is now a member of the stafT of 
the Division of Dermatology at the School of ^Medicine. Dr. Strahan is also associ- 
ated in private practice with Dr. Harry M. Robinson, Jr. 

Dr. Joseph D. Lichtenberg, class of 1950, has announced the opening of his ofBce 
for the practice of psychiatry at 11 East Chase Street, Baltimore 2 ^Maryland. 

Dr. Henry J. Walton, Professor Emeritus of Roentgenology, Dr. Walter L. Kilby 
and Dr. Charles N. Davidson have announced the association of Dr. Henry H. 
Startman, Jr., class of 1950, in the practice of roentgenology. They have also an- 
nounced the opening of a new branch office at 7307 York Road, Towson 4, Maryland. 

Dr. Stephen K. Padussis, class of 1948, has announced the opening of his office at 
401-402 Medical Arts Building in Baltimore. Dr. Padussis is engaged in the practice 
of general surgery. 

Dr. William G. Thuss, Jr., class of 1948, has announced his return to active practice 
with the Thuss Clinic for Industrial Medicine and Surgery at 2230 3rd x\ venue, 
North, Birmingham 3 Alabama. In June, 1956, he received the degree of Doctor of 
Science in Industrial ^Medicine from the University of Cincinnati, following a three 
year Fellowship in Industrial Medicine at the Kettering Laboratory of the College 
of Medicine of the L^niversity of Cincinnati. 

Dr. Robert W. Farr, class of 1934, has been recently elected president of the 
Maryland .\cademy of General Practice. 

Dr. Harry M. Robinson, Jr. Professor of Dermatology, has recently been elected 
a councilor of the Southern Medical Association representing the State of ^Maryland. 
Dr. Robinson will replace Dr. J. Morris Reese, class of 1920, who has completed his 
term of office on the Council. Dr. Harry M. Robinson, Jr., Dr. R. C. V. Robinson 
and Dr. John F. Strahan ])resented an exhibit on "Tranquilizers in Dermatology" 
at the meeting of the Southern Medical Association in Washington, D.C. in Novem- 
ber, 1956. The same exhibit was presented at the meeting of the American Academy 
of Dermatology in December. Drs. Harry M. Robinson, Jr., R. C. V. Robinson and 
John F. Strahan also presented a paper before the Southern Medical Association 
entitled "Hydroxizine Hydrochloride a New Tranquilizer". 

Dr. Francis A. Ellis, class of 1925, was a panelist on the symposium of "Histopa- 
thology of Skin Diseases" held for the section of dermatologists during the meeting 
of the Southern Medical Association in November, 1956. Dr. Ellis was also a partici- 
pant teacher in pathology at the meeting of the American Academy of Dermatology 
in Chicago in December, 1956. 

Dr. Francis J. Borges, class of 1950, is currently Chairman of the Rehabilitation 
Program of the Heart Association of Marvland. 



xvi BLLLETIX OF THE SC/I(X)L OF MEDICIXE, U. OF MD. 

Dr. Jose Alvarez de Choudens, class of 1944, now on duty with the United States 
Navy at ilie United Slates Xaval Hospital at St. Albans, New York, has been re- 
cently promoted to Commander in the Medical Corps, United States Naval Reserves. 
Dr. Alvarez will shortly complete his tour of duty and will return to his practice in 
San Juan, Puerto Rico. 

Dr. Aaron Finegold, class of \9-i.^, is currently serving as Instructor in Neurology 
at the University of Pittsburgh School of Medicine. Dr. Finegold was a recent visitor 
to Baltimore on the occasion of the Phi Delta Epsilon alumni club dinner. 

Dr. John D. Rosin, class of 1942, is currently serving as vice-president of the 
Baltimore graduate club of Phi Delta Ej)silon fraternity. 




amefican medical 
education foundatio 

535 N. Dearborn Street, Chicago 10, 

* This space contributed by the publisher 



0hitnavit^ 

Dr. Oliver S. Lloyd 

Dr. Lloyd was born al Western Run, Baltimore County, Maryland, Jul}' 9, 1884 
and was graduated by the College of Physicians and Surgeons, now combined with 
the University of Maryland, in 1909. As a house-otlicer at Mercy Hospital, Dr. Lloyd 
quickly established himself as reliable and capable, resulting in his becoming the 
resident surgeon and being chosen subsecjuently to work with Dr. A. C. Harrison for 
a time. His private practice grew rapidly and his reputation earned him many places 
of importance. He became surgeon to the Baltimore City Fire Department in 1928, 
serving them for nearly 2S years. He was on the staffs of Mercy Hospital, Lutheran 
Hospital and the South Baltimore Ceneral Hospital, being chief surgeon of the 
South Baltimore (ieneral Hospital from 1945 to 1952, when he resigned. 




The Lloyd ILp Screw In Place 



Dr. Oliver S. Lloyd 



He was a member of the American College of Surgeons, International Surgical 
Congress, Southeastern Surgical Congress, Southern Medical Association, .\merican 
Medical .Association and the Baltimore City Medical Society. 

He was a member of the Baltimore Country Club, Skytop Club and was closely 
associated with the Young .Men's Christian Association for more than 45 years. 

Dr. Lloyd was quite athletic, his greatest interest, perhajjs, being wrestling, which 
carried him from the local YMCA to neighboring places, such as matches at the 
United States Naval Academy. 

Many instances of his moral and physical courage could be related. We will omit 
the events that gave rise to e.xamples of the former and mention only two or three 
of the latter. 



xviii BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

A "bum" found slee{)ing in the hospital hallway was ordered out. Instead of leaving 
as ordered, he grabbed a piece of furniture and started for Dr. Lloyd. In a few seconds 
he was out on his ear. In a minute or two Lloyd, who was on accident duty, was 
called to treat a patient, who had fallen down the steps and hurt himselfl 

A pick-pocket at Pimlico was not too deft and Dr. Lloyd felt the filching of his 
watch. The pick-pocket was unfortunate in choosing his victim. In two seconds he 
was on the ground being held for the police. 

When the Baltimore Country Club burned, Dr. Lloyd, in his capacity as fire 
surgeon, went under the burning building and rescued an injured fireman. Such an 
act, plus his devotion to duty and kindness, endeared him to the whole Fire Depart- 
ment and their respect and admiration were evidenced by their tribute at his funeral. 

Dr. Lloyd was endowed with the qualifications of a good practical clinical surgeon, 
with an excellent mechanical turn, plus interest in the scientific facets of problems. 
He contributed to surgery one of the most ingenious instruments for internal fixation 
of fractures of the neck of the femur the Lloyd lag screw or Lloyd hip screw. In the 
development of this instrument, he made a deep study of various metals, their 
tensile strength, their tendency to corrosion, their production of electrolysis and the 
mechanics of different kinds and depths of threads of the screw, etc. This screw has 
been used successfully by many general surgeons and orthopedists and its originator 
developed quite a consulting practice in the treatment of broken hips. 

It is somewhat of a coincidence that two graduates of the College of Physicians 
and Surgeons, within a year of each other. Dr. H. H. Haynes — 1908 and Dr. Lloyd 
1909, without association or collaboration, should have made reputations in the 
treatment of fractures by ingenious fracture apparatus. 

Ollie Lloyd had a square jaw, square shoulders and thought and acted in a square 
manner. He could not do a mean act but he dearly loved to do a kind one. He merited 
and received the love and admiration of his patients, his countless friends and his 
family. 

Dr. Lloyd died October 27th, 1956. He is survived by his wife, the former, Miss 
Jane Scott; a son, Galvin Lloyd, of Winchester, Va; and a daughter, Mrs. Frederick 
Stuart, Jr., of Baltimore; a sister, JNIrs. Ethel Lloyd Morse, of Baltimore and a 
brother, Lowndes Lloyd, of Syracuse, N. Y. 

Walter D. Wise, M.D. 

Dr. Marvin T. Sudler 

Dr. Mervin Tubman Sudler, class of 1901, P & S, and former Dean of the Kansas 
L^niversity School of Medicine, died on June 22, 1956, aged 80. 

Born in Westover, Maryland, Dr. Sudler received his Bachelor of Science degree 
from the Maryland Agricultural College in 1894 and his degree of Doctor of Phi- 
losophy in 1899 from the Johns Hopkins University. He then enrolled in the College 
of Physicians and Surgeons in Baltimore, receiving the degree of Doctor of Medicine 
in 1901. 

Dr. Sudler was a Fellow of the American College of Surgeons, a member of the 
American Medical Association and the Nu Sigma Nu medical fraternity. 



OBITUARIES xix 

Dr. Louis K. Walker 

Dr. Louis Kyle Walker, class of 1^)11, flied May 17, 1056, at Ahoskie, Xorth Taro- 
lina, aged 67. 

A graduate of the I'liiversily of Xorth Carolina and the University of Maryhmd 
School of Medicine, Dr. Walker began the j^ractice of medicine in Ahoskie in 1014 
and was later appointed chief of staff of the Roanoke-Chowan Hospital in that city. 

He was a member of the Hertford County and Xorth Carolina Medical Societies 
and was acti\'e in cancer, tuberculosis and Red Cross campaigns. 

Dr. Paul E. Carliner 

Dr. Paul E. Carliner, class of 10,U, a prominent research scientist, died October 1,S, 
1056, aged 46. 

Dr. Carliner was pre-eminently known for the development of the drug dramamine, 
often referred to as one of the miracle drugs. First used for the treatment of seasick- 
ness during World War U, the drug has become a standard remedy for this malady. 
Original research was done by Dr. Carliner in association with Dr. Leslie Gay on 
1,376 service men aboard an army transport in the rough Xorth Atlantic in Decem- 
ber, 1046. 

Dr. Carliner, who interned at Sinai Hospital, was later a resident physician there 
and was active on the staff of the Johns Hopkins Hospital. 

Dr. John Forsyth Aubrey 

John Forsyth Aubrey, an Army doctor who served in both World Wars, and a 
sanitation olHicer during the construction of the Panama Canal, died in Washington, 
D. C. on October 4, 1956, after a long illness. 

Dr. xAubrey was the son of the late Judge William Aubrey of San Antonio. His 
grandfather, John Forsyth, was a former governor of Georgia and served as Secretary 
of State under Presidents ^Martin \'an Buren and Andrew Jackson. 

Dr. Aubrey was born in Lynchburg, Virginia. He attended the University of Texas 
and Johns Ho{)kins University and received his medical degree from the University 
of Maryland in 1021. He lived in Baltimore for 30 years and served as surgeon at 
the Maryland State Penitentiary. He also was a member of the Baltimore Board of 
Fducation. 

Dr. Aubrey served as medical officer with the 20ih Division during World War T 
and was a surgeon at the Philadelphia Signal Depot during World War H. 

He was a member of the Baltimore City ^^ledical Society and the Medical and 
Chirurgiial I-'aculty of Maryland, the .\merican Medical Association, the Military 
College of Surgeons, the Panama Canal Society, the \'eterans of ^'orei^n Wars and 
the American Legion. 

He is survived by his wife, Florence Conner Aubrey of Miami, Florida, a daughter, 
Ann Aubrey Brown of Cambridge, Massachusetts, a sister, Eugenia Buckley of San 
Antonio, and one grandchild. 

i"\meral service were held at the l-Ori Mycr Chapel and burial was in the Arlington 
National Cemetery. 

John F. H()(;a.\, M.I). 



XX BLLLETIX OF THE .SCHOOL 01' MEDICINE, U. OF MD. 

Anderson, Richard Speight, W'hilakers, N. C; class of 1^24; served during World 
War II; agetl 57; died, June 6, 1956. 

Baum, Edward, Philadelphia, Pa.; B.M.C., class of 1895; aged 86; died, July 2, 
1956. 

Dufify, Vincent Paul, Graf Ion, W. \'a.; class of 1917; aged 72; died, May 3, 1956, 
of cerebral hemorrhage. 

Gorham, Herbert Jenkins, Nashville, N. C; class of 1926; aged 55; died, June 17, 
1956. 

Herbert, Alpha N,, Miami, Fla.; class of 1925; aged 55; died, June 22, 1956, of 
abdominal aneurysm. 

Hower, Heister V., Berwick, Pa.; P & S, class of 1887; aged 92; died, April 16, 
1956. 

Hundley, Preston G., Lynchburg, Va.; class of 1909; aged 76; died, April 28, 1956, 
of leukemia. 

Johnson, James White, Union Level, \^a.; B.^I.C, class of 1907; aged 76; died, 
.May 31, 1956. 

Johnston, Ernest H., Waterbury, Conn.; class of 1900; aged 77; died, May 3, 1956, 
of bronchopneumonia and adenocarcinoma of the rectosigmoid. 

Jones, Edgar A. P., Cambridge, Md.; B.M.C., class of 1893; aged 83; died. May 27, 
1956, of arteriosclerosis. 

Keim, Albert L., Pittsburgh, Pa.; B.M.C., class of 1913; aged 71; died, July 28, 
1956. 

Kelly, William Henry, Sanford, Me.; B.M.C., class of 1905; aged 87; died, Febru- 
ary 18, 1956, of coronary heart disease and arteriosclerosis. 

Marchant, J. Henry, Baltimore, Md.; class of 1891; also a dentist; died, July 2, 
1956. 

Noland, Stacy Taylor, Rehobeth Beach, Del; P & S, class of 1914; aged 66; served 
during World War I; died, July 17, 1956, of bronchogenic carcinoma. 

Palmateer, Arthur Clare, New York, N. Y. ; P & S, class of 1906; aged 74; died, 
April 27, 1956, following a gall bladder operation. 

Pulaski, Leo Edward, Shenandoah, Pa.; class of 1925; aged 57; died. May 6, 1956, 
of rheumatic heart disease. 

St. George, Archibald, South Swansea, Mass.; P & S, class of 1895; aged 88; died, 
June 16, 1956. 

Sisler, Franklin Herbert, Bristow, Okla.; P & S, class of 1910; aged 68; died, 
.\pril 7, 1956, of cerebrovascular accident. 

Sudler, Mervin Tubman, Lawrence, Kan.; P & S, 1901; aged 80; died, June 22, 
1956, of coronary occlusion. 

Walker, Louis Kyle, Ahoskie, N. C; class of 1911; aged 67; died, May 17, 1956, 
of pneumonia and cerebral hemorrhage. 



MEDICAL SCHOOL SECTION 



AIEET THE EMERITI 

Dr. Irving J. Spear is celebrating 
his 80th birthday this year. He was 
born in Alsfeld, Germany, March 
10, 1877 while his parents were 
visiting relatives abroad. Both his 
parents were born and raised in 
Baltimore, as was Dr. Spear. His 
father was a prosperous owner of a 
shoe store on Pratt Street and was 
proud and ambitious for his son. 
Young Irving attended the public 
schools for his elementary educa- 
tion and graduated from Balti- 
more City College in 1896. 

He had decided early on medi- 
cine as a career and chose the Uni- 
versity of Maryland from among 
the many medical schools that 
were then existent in Baltimore. 
The prominent professors at the 
institution in those days were: Tif- 
fany, Winslow, Gilchrist, and 
Chew. After graduation. Dr. Spear 
took an internship at Bay View, 
the present Baltimore City Hos- 
pitals. His interest was already in 
neuro-psychiatry. While at Bay 
View he gained experience under 
the direction of Dr. Henry J. Burk- 
ley, the professor at Johns Hop- 
kins. 

Dr. Spear then soughl lo further 
broaden his training and spent two 
years at clinics in Munich, Vienna, 
Berlin and Paris. It was the in- 
variable custom in those days to 
polish ofT a medical education by 
spending some time abroad. He 
returned to Baltimore as Superintendent of the Psychiatric Division at Bay View 
in 1903. He immediately associated himself with his .\lma Mater in a teaching 




ii in LLETIX 01' THE SCHOOL OF MEDICI XE, C. OF MI). 

capatily and this relationship has remained for over 50 years. Dr. McElfresh was 
Professor of Neuropsychiatry at this time. Dr. Spear assumed greater teaching re- 
sponsibiHty in the department from 1<X)4 to 1915. He followed Dr. Kit hardson as 
Professor. About tliis time, he compiled a te.xtbook entitled "Manual of Nerv- 
ous Diseases", published in 1916 by W. B. Saunders and used by the School of Medi- 
cine as a students' text for a number of years. 

Dr. Spear offered his services to his country with the outbreak of World War I 
and enlisted with the rank of captain. His assignment was at Fort McPherson in 
Atlanta. At this hospital he worked with Dr. Habcock as his Commanding Officer, 
diagnosing, evaluating and treating the many cases of traumatic nerve injuries 
shipped back from the battletields of France. Dr. Babcock's special interest at this 
time was nerve surgery. Together they reported on over 2,000 cases of nerve injury 
treated surgically. 

Dr. Spear returned to Baltimore in the fall of 1919 with the rank of major. He 
took up his duties as Professor at the University and again became active in his con- 
sultant practice. Dr. George Settle was acting Professor in Dr. Spear's absence. The 
outpatient clinic was exceedingly active at this time in neuro-psychiatry, being the 
largest clinic at the University. 

The departments of neurology and psychiatry were combined up to the advent of 
Dr. Ross Chapman in about 1925. Dr. Spear continued as Professor of Neurology 
until his retirement to Emeritus Professor. He has maintained an active private 
practice in neuropsychiatry since his return from Europe in 1903. In a consultant 
capacity he is still active in insurance and court work within his specialty. In addi- 
tion to his textbook he has contributed over 200 articles to the medical literature. 

In 1907 Dr. Spear married his childhood sweetheart, Hortense Hamburger Green- 
wald. She was an artist of some accomplishment and many of her paintings adorn 
the walls of Dr. Spear's apartment. They enjoyed almost 40 years of happy married 
life together until her death in 1948. There were no children. Dr. and Mrs. Spear 
traveled widely during their vacation periods. He was also a constant attendant at 
medical meetings and conventions of neuropsychiatrists. 

Dr. Spear continues his interest in the arts and his apartment contains many an- 
tiques, prints and figurines collected and treasured by Mrs. Spear and himself through 
the years. 

Dr. Spear is a gentleman physician of the old school, a charming conversationalist 
and still keen in all his faculties. 

We salute this Octogenarian among our Emeritus Professors. 



HAVE YOU 
GIVEN TO 
EASTER SEALS? 




National Society 

for 

Crippled Children 

and Adults 

11 So. LaSalle, Chicago 3 



ALUMNI ASSOCIATION SECTION 



oirrAix VOIR coalmemorative medal now 




The Medical Alumni Association can still offer a few of the fine, registered silver 
medals struck in commemoration of the 150th Anniversary of the School of Medicine. 
These may be obtained by writing the Medical Alumni Association, Lombard and 
(ireene Streets, Baltimore 1, Maryland. Prices are as follows: 

Silver— S6. 00 plus S.60 Federal Tax and S.12 ^Maryland State Sales Tax (where 
applicable) 

Bronze— $3.00 plus S.06 Maryland State Sales Tax (where applicable) 

All medals will be sent postpaid upon receipt of remittance. Fifty cents should be 
added to the above prices if the purchaser desires the order to be registered or insured. 




Equipment and Supplies for: 

Pnysicians ana Surgeons * Hospitala 

Laboratories * Inaustrial Clinics 



AfuRRAY-^AUMGARTNER 
SURGICAL INSTRUMENT COMPANY, INC. 

5 West Chase Street • SArato^a 7-7333 
Baltimore L Maryland 



iv BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

MEDIC\L LIBRARY NOTES 

Books and journals were received from the following donors between August 1, 
1956 and February 1, 1957: 

Dr. Charles Bagley, Jr. Dr. Samuel M. Jacobson 

Dr. Alice Band Dr. Arthur M. Kraut 

Dr. Eugene Blank Mr. Bertram Ney 

Dr. Louis V. Blum Dr. Robert T. Parker 

Dr. Robert W. Bu.xton Dr. Maurice C. Pincoflfs 

Dr. Henry V. Chase Dr. Harry ^V. Robinson, Sr. 

Mrs. Samuel B. Dove Dr. John E. Savage 

Dr. V. Reid Edwards Miss Ida W. Schuman 

Dr. Samuel S. Click Dr. Douglas Smith 

Dr. Frank W. Hachtel Mr. H. J. Sobiloff 

Dr. INIanuel D. Hornedo Dr. John A. Wagner 

Hynson, Westcott, and Dunning Dr. Charles H. Williams 

Dr. George H. Yaeger 

Generous checks have been received from Dr. Arthur M. Kraut and Dr. A. Frank 
Thompson, Jr. 

THE LIBRARY BUILDING 

In the first weeks of 1957 Davidge Hall, two adjoining buildings on Lombard 
Street, and one on Lemmon Street were torn down to provide the site for the library 
building which will combine the present libraries of medicine, dentistry, pharmacy, 
nursing, and psychiatry. The Bulletin here presents an architectural representation 
to give some impression of the ultimate appearance of the new health sciences 
librar>\ 

Such drawings, however, in their reproduction for the printed page, cannot neces- 
sarily convey a full picture. For example, it is hardly clear in the accompanying 
photograph that the new library building will be three stories high (with a fourth 
floor of basement also at the south end). The incline of Greene Street, which is 
greater than appears to the casual eye, determines the level of the ground floor, with 
the north end partly below ground but the south end at street level. In the picture, 
this floor is obscured by suggested planting along the grass plot surrounding the 
north and west sides of the library. 

Probably the two most serious errors made in library planning are these: lack of 
allowance for future growth, and failure to plan functionally from the inside to the 
out. Verified statistics assembled by library experts over the years show that active 
college libraries double their book collections at least every sixteen years. Planning 
a costly building, expected to last indefinitely, makes it vital to allow expansion 
which may seem almost unbelievable at the start. The agreement of the University 
and of State officials in permitting this building to be planned of ample size and so 
constructed that another story of book stacks may eventually be added shows unu- 
sual insight. This plan to provide for the far future was another factor, of course, in 
determining the design of the library; obviously a later addition could be superim- 



MEDICAL SCHOOL SECTION 



w 




SOOx\ TO RISE 

Architect's drawing of new Library Building which will shortly be constructed on the site of 

Davidge Hall 



posed only on a flat roof. The setting for the building also had to be limited to a 
narrow strip of ''campus" on two sides, in order to have enough space for the modular 
requirements of the basic structure. 

Administrative wisdom was likewise evident in the procedure which allowed 
planning to begin from the inside of the building, with needs of a smoothly functioning 
library the criterion. The director of libraries and the medical librarian, with help 
from the library staff, experimented with various plans before beginning official work 
with the architect, and thereafter in coordination with the architect's contribution. 
Since a main entrance on Lombard Street or at the corner appeared desirable, at- 
tempts were made to design a satisfactory interior leading to the narrower side of 
the building. This proved impracticable if optimum arrangement and control were 
to be maintained, reading rooms placed at the favorable north end, and long, objec- 
tionable corridors avoided. The best interior plans that could be devised [)laced the 
entrance at about center on Greene Street. When the preliminary plans for our 
library building were presented for criticism at the national Library Buildings Plan 
Institute (held yearly for people planning college and reference libraries) the arrange- 
ment was pronounced basically sound and advisable by library building consultants 
and other experts there. 

When the major interior i)lanning had been established, the Board of Regents of 
the L^niversity and officials responsible for State buildings decided upon the exterior 
of the library from a series of architectural designs ranging from colonial to modern. 
The ultimate choice was perhaps influenced by knowledge that across from the 



vi BILLETIS Ol- Till: SCHOOL OF MKDICIXK, T. 0/' MD. 

library on Greene Street will later he erei ted (replacing the old I'nixersity (Minic 
building) a student-faculty union huikling of ultra-modern api)earance. The motif 
at the entrance of the library, however, is taken from that of the Hressler building 
and the University Hospital. \ot unlil the library building itself appears can we 
gain a full conception of its image. 

In the next issue of the Bulletin, letters will be quoted from two library-minded 
alumni, located in different parts of the country but sharing and expressing the same 
interest in the library. These two friends have been regularly contributing money 
which is deposited in the Ruth Lee Briscoe Library Fund to be expended for any 
library needs. Currently some of these funds are being used toward the binding of 
many back volumes of medical journals which have formerly had to remain unbound. 
Li view of the new library building, it seems of special im{)ortance to get the peri- 
odical collection into the best condition for use and for preservation. 

FACULTY MEMBER HEADS AMERICAN CHEMICAL 
SOCIETY GROUP 

Dr. Raymond !^L Burgison, Assistant Professor of Pharmacology, has recently been 
elected chairman of the Marvland section of the American Chemical Societv. 



MARYLAND STUDENT ACiAlN WINS SCHERING AWARD 

^Ir. Richard K. B. Ho of Hawaii and a senior in the School of ^ledicine, was re- 
cently awarded the annual 8500 prize and special award certiticate for his research 
paper entitled "The Clinical L'se of Adrenocortical Steroids in Collagen Diseases". 




yir. Richard Ho receives his prize from Dr. C J. Szmal of the Schering Corporation. I., to r. — 
Mr. He's son, Stephen. Mrs. Ho, Mr. Ho, Dr. Szmal and Dean William S. Stone. 



MEDICAL SCHOOL SECTION vii 

The annual award sj)()nsored by the Schering rori)f)ration was presented to Mr. Ho 
at ceremonies in the olHice of the Dean of the School of Medicine. 

Established in 1040, the contest usually offers prizes to medical students for best 
paper submitted on three selected medical loj)ics of current interest. 

MERCY HOSPITAL SECTION 
MEMBERS or THE VISITING STAFF APPEAR OX T\' 

Dr. Walter D. Wise, Chairman of the Board of Governors, appeared as a guest on 
"Your Family Doctor" presented on W'MAR-T\' on November 30th. 

In an interview regarding the Mercy Hospital Building Fund, Dr. Wise discussed 
the City's need for hospital beds and showed models of the 21-story New Mercy 
Hospital. 

r)n January 6th, Dr. Daniel J. Pessagno, C hief of Surgery, Dr. Patrick ('. Phelan, 
Jr. and Dr. William B. Rever, Jr., members of the Visiting Surgical Stafif, appeared 
on the weekly Sunday Program T\'-]\ID. Their topic of discussion was "Intestinal 
Obstruction." 

On April 14th, Dr. H. Raymond Peters, Chief of Medicine and Dr. Robert E. 
Ensor, who is in charge of the Anticoagulant Laboratory at Mercy will appear on 
T\'-MD. They will discuss "The Use of Anticoagulants in Coronary Thrombosis." 

FOUR MEMBERS OF THE VISITING STAFF RETURN 
FROM :\1ILITARY DUTY 

Four members of the X'isiting Staff returned to Mercy after completing tours of 
military duly, they are: Dr. James Russo, Medical Anesthetist and Head of the 
Department of Anesthesia, Dr. William Dunnigan, Dr. Edward P. Coffay, Jr. and 
Dr. Frank Faraino. 

Dr. Calvin Y. Hadidian, a member of the X'isiting Surgical Staff at Mercy, left 
Baltimore to establish a practice in Cumberland, Maryland. In addition to his work 
at Mercy, Dr. Hadidian was also a member of the Teaching Stafif of the University of 
-Maryland School of Medic ine. 

RESIDENT IN PEDIATRICS ATTENDS COURSES 

Dr. (ieorge M. Bauernsc hub, Jr., Resident in Pediatrics, took a course in Pediatric 
Cardiology at Cook County Graduate School of Medicine from November 5-llth. 
From November 12 15th he attended a course in Pediatric Endocrinology and Re- 
lated Metabolism at New York University Post Graduate Medical School. 

CARDIO-Pl LMONARY LABORATORY TO BE STARTED 

Mercy Hospital is in the i)rocess of establishing a Pulmonary Function and Cardiac 
Catheterization Laboratory which will open in March or April. This new laboratory 
one of the very few in the General \'olunlary Hospitals, will be headed by Bruce W. 
Armstrong, M.I). Dr. .\rmstrong was formerly in charge of the Cardio-Pulmonary 



viii BULLETIN OF THE SCHOOL OF MEDICIXE, U. OF MD. 

Laboratory at the Loch Raven \'eterans Hospital. He is Assistant Professor of 
Surgery at the University of ^Liryland School of Medicine. 

In addition to Dr. Armstrong the laboratory will be staffed by several technicians. 
The Resident in Thoracic Surgery will have in his training, duties in the laboratory. 

CHIEF OF PATHOLOGY ATTENDS MEETING 

Dr. C. Gardner Warner, Chief of the Pathological Department, recently attended 
the annual meeting of the College of American Pathologists at the Drake Hotel, 
Chicago, October 7th-12th. The sessions were chiefly directed toward the cyto- 
logic diagnoses of cancer. 




amefican medical 
education foundatic 

535 N. Dearborn Street, Chicago 10, 

• This space contributed by the publisher 



POST GRADUATE COMMITTEE SECTION 
POST GRADUATE COMMITTEE, SCHOOL OF MEDICINE 

HOWARD M. BUBERT, M.D., Chairman and Director 
Elizabeth Carroll, Executive Secretary 

Post Graduate Office: Room 201 

Old Medical Building, Lombard and Greene Streets 

Baltimore 1, Maryland 

BASIC SCIENCES 

The Postgraduate course Basic Sciences as They Apply to the Practice of Medicine 
began on January 9 with an enrollment of fifty physicians from all sections of the 
state. Up to this writing, hazardous road conditions on occasion notwithstanding, 
attendance has been most gratifying. This is a 21 week, 42 hour course for which full 
Category I credit is allowed by the American Academy of General Practice. 

MEDICAL CRUISE 

The Postgraduate Committee is planning a medical cruise to the Caribbean in the 
fall of 1957. During the cruise twenty hours of postgraduate teaching will be given 
for which credit will be allowed by the American Academy of General Practice. The 
complete program and further details of the cruise will be included in this section 
of the July issue of the Bulletix of the School of Medicine. 

SURGICAL ANATOMY 

The postgraduate course Surgical Anatomy under Dr. Otto C. Brantigan 
continues to retain its popularity from year to year. This course begins with the 
second semester of the medical school and continues through May. Enrollment is 
necessarily limited. 

SYMPOSIUM ON INDUSTRIAL MEDICINE 

The Postgraduate Committee of the School of Medicine will sponsor a symposium 
on Industrial Medicine at the School of Medicine on May 14, 15, and 16, 1957. 

The symposium will cover problems in the screening and reporting on the medical 
examination of employees, selected industrial health problems of importance, and 
the importance of professional understanding and cooperation between general 
practitioners and physicians in industrial medicine. 

The tentative program being prepared covers the following subjects: 

Tuesday, May 14 

1. A safety engineer looks at industrial medicine 

Discussion 

2. The toxicology of volatile solvents and gases in industrial practices 

Discussion 



X Bl'LLETiy or THE SCHOOL OF MEDICIXE, U. OF MD. 

3. Protective measures required for safe operations wliere volatile solvents are 
used in industry 

Discussion 

4. Radiation hazards in industry 

Discussion 

5. Protective measures required where radiation liazards exist 

Discussion 

6. Alcoholism as a problem in industrial manpower 

Discussion 
Wednesday, May 15 

1. Visual examinations and their significance 

Discussion 

2. Pre-emplo}'ment psychologic screening of employees for job placement or 
reassignment 

Discussion 

3. Hearing problems and noise control 

Discussion 

4. Health interviewing methods 

Discussion 

5. The importance of a general physical examination, including the use of roent- 
genology in a pre-employment examination 

Discussion 

6. Medical screening and job placement of the handicapped 

Discussion 

7. Attendance Motivations 

Discussion 

Thursday, May 16 

1. The significance of adequate medical records in industrial medical practice 

Discussion 

2. The general practitioner's letter to industry covering the condition of employees 
when they return to work or the G.P. and his relationshij) to industry 

Discussion 

3. The medical aspects of claims and insurance 

Discussion 

4. Rehabilitation 

Discussion 

5. The treatment of industrial workers presenting acute medical emergencies 

Discussion 

6. Drugs and biologicals— their use and abuse as they affect the industrial worker 

Discussion 

It is expected that a group of outstanding authorities will be assembled to present 
the program and participate in the discussions. It is believed that physicians in 
Maryland interested in cooperating or participating in the industrial development 
of the State by improving the quality of industrial medicine will find this symposium 
stimulating and informative. 



ALUMNI ASSOCIATION SECTION 



OFFICERS* 

J. Sheldon Eastland, M.D., President 
WiLLL\M B. Long, M.D., President-elect 

Vice-Presidents 

A. Harry Finkelstein, M.D. Arthur Siwinski, M.D. Martin Strobel, M.D. 

Edwin H. Stewart, Jr., M.D., Secretary Ernest I. Cornbrooks, Jr., M.D., Treasurer 

J. Emmett Queen, M.D., Assistant Secretary Minette E. Scott, Executive Secretary 

William H. Triplett, M.D., Director 



Board of Directors 
J. Morris Reese, M.D., 

Chairman 
J. Sheldon Eastland, M.D. 
Ernest I. Cornbrooks, Jr., M.D. 
Edwin H. Stewart, Jr., M.D 
Simon Bracer, M.D. 
Frank N. Ogden, M.D. 
H. Boyd VVylie, M.D. 
J. Emmett Queen, M.D. 
Gibson J. Wells, M.D. 
William H. Triplett, M.D. 
William B. Long, M.D. 



Nominating Committee 
Emanuel Schimunek, M.D., 
Chairman 
Dexter L. Reimann, M.D. 
Edwin S. Muller, M.D. 
J. Howard Franz, M.D. 
Howard B. Mays, M.D. 



Representatives to General 
Alumni Board 
William H. Triplett, M.D. 
Thurston R. Adams, M.D. 
Daniel J. Pessagno, M.D. 



Library Committee 

Milton S. Sacks, M.D. 

Representatives, Editorial Board, 

Bulletin 

Harry C. Hull, M.D. 

Albert E. Goldstein, M.D. 

J. Sheldon Eastland, M.D. 

(ex-ofl5cio) 

Representatives, Advisory Board, 

Faculty 

William H. Triplett, M.D. 

Albert E. Goldstein, M.D. 

Edwin H. Stewart, M.D. 



DEAN'S LETTER 

Dear Members of the Alumni and Friends: 

Some confusion has arisen in regard to the relationship of the National Fund for 
Medical Education and the American Medical Education Foundation. 

The National Fund for Medical Education is organized primarily by business 
executives as a foundation to obtain unrestricted gifts from industry and philanthro- 
pists to aid medical education. 

The American Medical Education Foundation is a foundation under the auspices 
of the American Medical Association primarily organized to receive gifts from physi- 
cians, either unrestricted or designated, for a specific medical school. 

Formerly the contributions from both foundations were combined and forwarded 
to the medical schools as one check. 

During the past year the foundations were separated in their operation and giving, 
because the A.M. A. thought it could better rej)resent the needs of medical schools 
to physicians than it was possible lo do when combined with the National Fund for 
Medical Education. 

Prior to the separation, the I-"ord I-'oundalion had agreed with the National Fund 
for Medical Education to match unrestricted funds given to medical schools by a 
contribution of an additional 70'^ of all contributions up to the amount received 



xii RVLLETIX OF THE SCHOOL OF MEDICIXE, U. OF .\fD. 

the previous year and a 1(K)'^( match for all funds contributed above that previously 
experienced. With this provision, unrestricted funds contributed to A.M.E.F. would 
participate in Ford matching as long as A.M.E.F. remained united in its giving with 
the National Fund for Medical Education. 

However, the A.M. A decided to separate from the National Fund and thus became 
ineligible for Ford matching money. However, to make up for the loss of income from 
the Ford contribution, the A.M. A. contributed S125,000 from its funds to the A.M. 
E.F. which represented approximately the amount that would have been derived 
from the Ford Fund. 

This year we will receive your contributions and our share of the unrestricted 
funds and matching A.M. A. money from the A.M.E.F. We will also receive a contri- 
bution from the National Fund for Medical Education. 

I am sure you would like to know how this money is being used. Last year 
815,600 was used to pay faculty salaries that could not be provided through the 

regular ajipropriation. 
87,500 was used to initiate a much needed addition of e.xperimental pathology to 

the instruction in pathology. 
8>^,000 was used to purchase new equipment needed in our experimental studies. 
S2,0(X) is being used in faculty travel to scientific meetings to present papers and 

gain information vital in improving our teaching program. 

These and other factors have led to a tripling of our research program during the 
past two years and to great improvement of the undergraduate and house officer 
education programs. 

The average cost of undergraduate medical education per student per year in the 
United States is approximately 83,648.00. The University of Maryland has about 
82,934.00 per student per year to conduct its educational program. That is 8600.00 
less than the average provided for in the United States. We are trying to increase 
our State participation, but we need help. Funds contributed to A.M.E.F. are of 
great assistance and every dollar given comes to the medical schools. The A.M. A. 
absorbs all overhead. 

Sincerely, 

William S. Stone, M.D., De.^n 



ALUMNI ASSOCIATION SECTION 



IMPORTANT NOTICE 

The Medical Alumni Association announces a get-together for Mary- 
land alumni to be held on Wednesday, June 5, 1957, from 5:30 until 
7:30 P.M. during the annual meeting of the American Medical Associa- 
tion which will take place in New York City. 

The reunion will be held at the New York Coliseum, headquarters of 
the American IMedical Association. 

A committee headed by Dr. Joseph Nataro, Chairman, is in charge of 
arrangements. 

All Maryland alumni are cordially invited to attend and further in- 
formation may be obtained from the Medical Alumni Association or by 
directly contacting Dr. Joseph Nataro, 172 Littleton Avenue, Newark 3, 
New Jersey. 



EDITORIAL 

A living organization displays only the concerted strength and energies of its 
component parts; thus, the School of Medicine becomes not only a manifestation 
of the energies and confidence of its faculty but also of the enthusiasm and capacity 
of its students. Both student and faculty become a continuing entity, the student 
emerging as an alumnus after a four year formal curriculum. 

These alumni are not lost members of the intellectual team but are rather a con- 
tinuing pride of the faculty who assisted in the creation of the corpus alumni. Also, 
a common bond of interest extends between alumni, faculty and the institution 
from which they take pride in claiming a professional genesis. 

Thus, both faculty and alumni should take mutual pride in the achievements of 
one another. To this end, editorially, the Bulletin invites all alumni in a spirit of 
cooperative interest (and not with l^ashful reluctance) to send to the editor items of 
interest concerning themselves, their professional achievements and the achieve- 
ments of their immediate associates. 

The Bulletin will welcome such correspondence and will display it with j)ride, this 
pride pointing to the cooperative and coordinate achievements of both faculty and 
alumni. 

Correspondence should be sent directly to the Bulletin or to the medical editor. 



ORDER COMMEMORATIVE ITEMS NOW 
NOTICE 

CO]\IiMEMOR.\TIVE SESQUICENTENNIAL ITEMS ON 
SALE BY WOMEN'S AITXILIARY BOARD 




The items listed opposite are 
currently offered by the Women's 
Auxiliary Board of the University 
Hospital for sale during the Ses- 
quicentennial Year. 

Prices include the following. 
Large ash tray S5.00 
Small ash tray SL25 

Demi-tasse cup $2.50 

All inquiries and orders should be 
addressed to Gift Shop, University 
Hospital. 



ALUMNI ASSOCIATION SECTION xv 

FACULTY AND FRIENDS HONOR DR. ALBERT E. GOLDSTEIN 

More than 200 friends and faculty associates of Dr. Albert E. Goldstein gathered 
in his honor at a testimonial dinner held in his honor at the Sheraton-Belvedere Hotel 
on February 14, 1957. Dr. John G. Krantz, Jr. served as toastmaster. Speakers in- 
cluded Dr. Benjamin S. Abeshouse and Rev. John R. T. Hedeman. 

Dr. Goldstein was presented with a testimonial in recognition of his long associa- 
tion with the School of Medicine, his scientific achievements and the esteem in which 
his personal attributes were held by his fellow associates and colleagues. 

DR. SHIPLEY RESIGNS BULLETIN POST 

Dr. E. Roderick Shipley, for many years a very active member of the staff of the 
Bulletin, has recently tendered his resignation because of increased responsibilities 
in his practice and teaching in the School of Medicine. 

Dr. Shipley has served the Bulletin well as editor in charge of book reviews. 

EXCERPTA MEDICA LIFTS CURTAIN ON SOVIET MEDICINE 

As a result of plans initiated by the U. S. Public Health Service arrangements have 
recently been completed with Excerpta Medica Foundation, 2 East 103rd Street, 
New York 29, New York, whereby for the first time in the history of medicine an 
extensive review of the Soviet medical literature in all areas of medicine will now be 
available to medical science in the United States. 

The plan calls for the translation and publication of abstracts of Soviet medical 
literature, including reports of the work now being done in various cities throughout 
the U.S.S.R. Abstracts will be prepared by Soviet specialists most qualified to under- 
take the work. The material will then be edited and supervised by Excerpta Medica's 
own specialists and permanent Editorial Committee of thirty Soviet scientists ap- 
pointed by the Excerpta Medica Foundation in cooperation with the Presidium of 
the Academy of IVIedical Sciences of the U.S.S.R. These abstracts will be supple- 
mented by verbatim translations of abstracts of the Soviet literature in specially 
selected fields. 

All abstracts will be published under the title of "Abstracts of Soviet Medicine". 
Additional inquiries should be referred to Excerpta Medica Foundation, 2 East 
103rd Street, New York 29, New York. 

ANNUAL PEDIATRIC SEMINAR HELD MARCH 31, 1957 

As customary, the Department of Pediatrics of the School of ^ledicine held its 
annual pediatric seminar on Sunday, ^larch 31, 1957. An all-day meeting w'as de- 
signed specifically as an instrument of postgraduate education. Prominent speakers 
presented the following program: 

Recognition and Management of Pancreatic Deficiency — Dr. Harry Schwachman, 
Assistant Professor of Pediatrics, The Children's Medical Center, Boston, 
Massachusetts 

Pediatric Surgical Emergencies — Dr. Harry C. Bishop, The Children's Hospital of 
Philadelphia 



xvi BULLET IX OF THE SCHOOL OF MEDICINE, U. OF MD. 

Poisoning in Children — Dr. Edward Press, The American Pu])lic Health Association, 
Inc., New York, New York. 

Problems of Staphylococcal Infections in Children- Dr. Krwin Xeter, Associate Pro- 
fessor of Bacteriology, Children's Hospital, Buffalo, New York 

The committee members arranging this program included Dr. William M. Seabold, 
Dr. Israel P. Meranski and Dr. Frederick J. Heldrich, Jr., Chairman. 

:\1ARYLAND SOCIETY FOR .MEDICAL RESEARCH NEWS 

New Film on Medical Education Added to Society's Film Library 

A new lilm, a story of Medical Education in America entitled Danger at the Source, 
has recently been purchased and made available to its free loan library. The tilm was 
made in various medical schools and teaching hospitals under the auspices of the 
National Fund for ]\Iedical Education. A descriptive pamphlet of the film is available 
upon request to the Society's headquarters, 29 South Greene Street, Baltimore 1, 
Maryland. 

Maryland Society for ^Medical Research AD\nsES that the 
ANTi-\'nTSECTiONiSTS Are Again Acti\t 

Anti-viviseclionist Societies throughout the nation continue active and at present 
are considering the draft of a bill for submission to the next Congress ostensibly 
prohibiting the inter-state transport of animals for experimental purposes. 

PHI DELTA EPSILON LECTURE 

The annual lecture sponsored by the Phi Delta Epsilon Fraternity, held on JNlarch 
22, 1957, featured Dr. Paul Hoch, Commissioner of ISIental Hygiene of the State 
of New York. Dr. Hoch spoke on the topic ''The Use and Abuse of Tranquilizing 
Drugs". 

The lecture was held in Gordon Wilson Hall, University Hospital and has been 
an annual feature of the Phi Delta Epsilon Fraternity. 



(Dbituarie£f 

Dr. Emil Novak 
1884 1957 

On a warm sultry afternoon in the Spring of 1927, a group of third year students 
had gathered in the classroom for the lirsl lecture and laboratory exercise in gyneco- 
logic i)athology. The class was held in a rather untidy and crowded laboratory in the 
Pathology Building at the John Hopkins Hospital. Because of limited space the same 
course had to be repeated three times during the year. It was a popular course and 
each section was filled to the limit. On this particular afternoon the students were 
waiting for the instructor with only half-hearted enthusiasm for the weather, the 
short time that had elapsed since luncheon, and pre-occupation with plans for the 
nearing weekend were not conducive to alertness. Some students were chatting idly, 
some were adjusting their microscopes, and others seemed pre-occupied with noth- 
ingness. 

Suddenly there appeared at the door a handsome, robust, graying man. At once 
the entire room came to mental attention. Without being announced everyone knew 
that Emil Novak had arrived. His very presence was electrifying and each moment 
that passed brought every student more and more under his hypnotic power. The 
c lass lasted three hours and the time passed in what seemed to be a matter of min- 
utes. At the end of the period everyone was exhausted, but his brain was crammed 
with a well organized store of fresh facts. 

This was my first introduction to Emil Xovak, then a relatively young man. It 
became my good fortune to receive an internship in gynecology and to be kept on 
for 4 more years to become resident on the service. Dr. Novak was a potent force in 
my education and training each year; however, 1 of these years was spent in the 
gynecologic pathology laboratory and it was during this year that I came to know 
him closely, professionally as well as personally and socially. I learned how meticu- 
lous and e.xacting he could be. He would spend much time studying a section under 
the microscope, and when he made his diagnosis it was usually linal. Rarely did he 
c hange his opinion, and even more rarely was he found to be incorrect in his judg- 
ment. His facility in reading and speaking many foreign languages made him a 
walking bibliography, and since much of our basic knowledge in those days came 
from research done in foreign lands he was forever keeping his associates abreast of 
research done there. His unfailing fairness was another of his attributes. I helped 
Dr. Novak do some research work which turned out to be important enough to war- 
rant writing a report for publication. He was good enough to include my name in 
the title. Almost everyone who worked in the laboratory with him was stimulated 
1() do some important work in which he collaborated. Also to know Emil Novak 
socially and as a line family man was my privilege. In spite of days with every min- 
ute engaged in professional duties for U) or 12 hours he frequently entertained his 
staff and was a gracious host. His family was an unusually closely knit one and he 
was the adored and luimistakable head of it. 



BULLETIN OF THE SCHOOL OT MEDICINE, U. OF MD. 




It was my pleasure lo see Dr. Novak the recipient of many professional honors in 
this country and abroad. No one was ever more deserving, and no one else could 
have accepted so many so graciously. 

By fortunate coincidence my last contact with Emil Novak was at a meeting of 
the Maryland Obstetrical and Gynecological Society in December of 1956. He had 
been first president of the society in 1929, and was again elected president when it 
was re-organized in 1951. At the December meeting the society presented a portrait 
of its twice past {^resident to the Baltimore Medical and Chirurgical Faculty where 
it will hang with the portraits of other great men in Maryland medicine. This was 
an appropriate last tribute to a man who had been a guiding influence in the profes- 
sional life of almost every member present, and by a society which had been formed, 
and had prospered under his guidance. The great man who had nonchalantly ac- 



OB ITU ARIES xix 

cepted almost every honor in his field was visibly and warmly moved by this local 
tribute bestowed upon him by his own friends and confreres, and in the city where 
he had spent his entire life. 

John Herman Long, M.D. 

Dr. Edward Sooy Johnson 

Dr. Edward Sooy Johnson passed away at the age of 70 on Christmas Eve at his 
home in Baltimore very suddenly sitting on a chair in his living room. 

Dr. Johnson graduated from the University of Maryland School of Medicine in 
1912. He interned and served as resident at St. Joseph's Hospital in Baltimore, at 
the termination of which he became a member of the staff of that hospital. 

He was a member of the Baltimore City ]Medical Society, the Medical and Chi- 
rurgicai Faculty of Maryland, the American Medical Association and the American 
College of Surgeons and was a founder member of the American Board of Surgery. 
He had wide hospital activities in many of the Baltimore hospitals including St. 
Joseph's, Alercy, Lutheran, Franklin Square, South Baltimore General, Church 
Home and University Hospitals. He served for many years as Associate Professor of 
Surgery at his Alma Mater. 

Born in Snow Hill, Maryland, he was active in the Eastern Shore Society and was 
one of its past presidents. He served in the Medical Corps of the United States Army 
in France during World War I with Base Hospital Unit 48. 

John F. Hogan, M.D. 
P &S 1911 

Dr. Caldwell Woodruff 

Dr. Caldwell WoodrutY, well known Linthicum, Maryland physician, died on 
September 22, 1956, of a heart attack at the age of 74. Dr. Woodruff had suffered 
an attack of coronary thrombosis in 1936 at which time he retired from the active 
practice of medicine. 

Born in Charlotte, North Carolina on April 16, 1882, the son of George Egleston 
and Betty Caldwell Woodruff, he attended the Charlotte schools and later the Uni- 
versity of Xorth Carolina. He then entered the College of Physicians and Surgeons 
in Baltimore receiving his degree of doctor of medicine in 1911. Upon the completion 
of his internship at Mercy Hospital he entered the United Stales Public Health 
Service. Dr. Woodruff was a member of the National Guard and saw service on the 
Mexican Border. 

At the outbreak of World War I he was commissioned a captain in the Medical 
Corps of the United States Army and served in France with the 29th Division. 
Following the war, he moved to Linthicum and engagcfl in the active practice of 
medicine until his retirement in 1936. 

Dr. Woodruff was a former Chairman of the Anne Arundel County Sanitar>' Com- 
mission and in 1940 was appointed Chairman of the Glen Burnie Draft Board serving 
on the Board until January, 1955 both in Glen Burnie, Maryland and later in An- 
napolis. 



XX BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

He took a keen interest in genealogy having written many papers on the histories 
of families in North Carolina, South Carolina and Ceorgia. 

He was a member of the Episcopal Church; the Glen Burnie Rotary Club; CJlen 
Burnie Post 40, American Legion; Post 1, 29th Division Association; the Society of 
the Cincinnati; the Society of Colonial Wars, The Sons of the Revolution and the 
Sons of the American Revolution. 

Dr. Woodruff is survived by his widow, the former Beatrice de Forest of New York 
City, one son, three daughters and seven grandchildren. 

John F. Hog an, .M.D. 
Class of 1911, P & S 

Dr. William J. Coleman 

Dr. William J. Coleman, surgeon and former Superintendent of the University 
Hospital, died on November 25, 1956. He was 75 years old. 

A native of England, Dr. Coleman tirst settled in Connecticut and later was grad- 
uated from the School of Medicine in the class of 1906. At the outbreak of World 
War I he served as Superintendent of the University Hospital. Later, active in the 
National Guard, he served with 115th Infantry overseas and was discharged from 
the army with the rank of colonel in 1919. 

Returning to Baltimore he then began the practice of surgery and was active on 
the staff of the Maryland General Hospital. 

Dr. John Vincent O'Connor 

Dr. John V. O'Connor, P & S, class of 1911, died on September 14, 1956. He 
was 71. 

Long a registered pharmacist in the state of Rhode Island, after his graduation 
from the College of Physicians and Surgeons he became a member of the staff of the 
Woonsocket Hospital and ]Mercy Hospital in Woonsocket, Rhode Island. He was a 
past president of the Woonsocket District ^Medical Society, a member of the Rhode 
Island ^ledical Society and the American ^Medical Association. He was known as 
one of the leading internists in that section of New England. 

John F. Hogan, Sk., M.D. 
P & S 1911 

Dr. John Dawson Sturgeon, Sr. 

Dr. John D. Sturgeon, Sr., aged 102, one of the nation's oldest physicians and the 
oldest living graduate of the school of medicine, died at his home in Uniontown, 
Pennsylvania on February 15. (See Bulletin of the School of Medicine, University 
of Maryland, Vol. 39, October, 1954). 

Dr. Howard Lester Zupnick 

Dr. Howard L. Zupnick, class of 1932, and for many years active on the surgical 
staff of the School of Medicine, died at his home in Baltimore on February 15, 1957. 



BLLLETIX or THE SCHOOL OF MEDICIXR, I'. <>/■ MI). 




Dr. W. Houston Toulson, a long lime friend of Dr. PincofFs and Toastmaster presents him 
with a photograph of the Pincoffs Fellowship plaque which will be erected in Chemical Hall. 



of ]\Iedicine, Dr. Waller D. Wise, Dr. William H. Kouwenhoven and Dr. Theodore 
E. Woodward, Dr. Pincofif's successor as Professor of Medicine. 

A highlight of the dinner program was the presentation to Dr. Pincoflfs of an 
honorable citizen award in the name of the City of Baltimore which was presented 
by the Hon. Thomas D'Alesandro, Jr., Mayor of Baltimore. 



^e^umamal <z=^\ 



lit liiMicT or 

M^uucc C. pi..c4>.JI.3>.,J4.a.C.p. 

iH ccmntenti^tuttctt or hi.% 

and iJytev^entive yvleX^ULne 

aiiJi ItiA eminent cateer a.\ a 

iVluiiician^ J-eacltet, ^^ni^cMUfutot, \^ cunselot, 
uhJL ^ yleJiicui <=-^d/nLftisltatot 

al tlie 

<^cltooL OT yVieJLicine. LLnivetMLi or yl/LatiiianJi 



iftlffr,. 




v5litOTirraOTt"f 




^^ 



^fte <~^esciuicente$tmal Lft 
or tlte 
L \.ni\'etMlit t?r yyiatitlanJi 
.liiij 31, 1937 



eat. 



iv BLLLETIX OF THE SCHOOL OF MEDICI XE, L\ OF MD. 

Maurice C. Pincoffs, M.D., M.A.C.P. 

Dr. Pincoffs, whom we honor this evening, has enjoyed a distinguished 
career in American Medicine. He is a most respected member of the medical 
profession in Maryland and throughout the United States is regarded as the 
present dav Oslerian Physician. 

Maurice Pincofts received the Bachelor of Science degree from the Uni- 
versity of Chicago in 1909. His degree of Medicine was awarded by the 
Johns Hopkins L niversity School of Medicine in 1912. As a medical student 




Maurice C. Pincoffs, M D.. M.A.C.P 



and later as a house officer first at the Presbyterian Hospital in Chicago and 
subsequently at the Baltimore City Hospitals from 1913-1915, Dr. Pincoffs 
displayed traits of excellence. His evaluation of patients was refreshingly 
thorough and his final analysis of a difficult clinical problem was always 
critical and precise. These natural characteristics were strengthened by his 
unusual ability to retain information gleaned from the medical literatures. 
For his outstanding record during World War 1, he was awarded the 
Distinguished Service Cross and the Croix de Guerre with Palm. One of 
his confreres, unable to attend the dinner this evening, recently expressed 
appropriately. "From our association in France those many years ago, I 



MEDICAL SCHOOL SECTION v 

retain a very high regard for his indomitable courage in his personal partici- 
pation in the evacuation of our v^/oundcd from the battlefield, and for the 
high morale which he maintained among his subordinates." 

The period of 1922 to 1954 when Maurice PincofFs was Head of the 
Department of Medicine of the School of Medicine, University of Mary- 
land, was one of intensive growth in American Medicine. He contributed 
his excellent qualities of leadership and mature abilities as a clinician and 
teacher into planting the seeds of thoroughness and the principles of caring 
for the patient as a whole in students and physicians training under him. 
Many of his former residents have gathered to pay him homage tonight. 
They continue to practice and teach the principles of quality which he has 
generously bequeathed. The many students of medicine who have had the 
privilege of association with the master have learned by his words but 
equally by emulating the principles which he practiced. To him a diagnosis 
has never been one of hasty judgment, but one of analysis designed for the 
particular individual problem at hand. Dr. PincofTs has practiced "compre- 
hensive medicine" long before the expression was coined. His students sense 
this and regard this attribute as one of his greatest. Were his good friend and 
former associate for many years. Dr. Arthur M. Shipley, with us this even- 
ing, he might say: 'Tincoffs has an uncanny instinct for solving a difficult 
clinical problem; he will not stop until the answer is correct or as nearly so 
as is humanly possible." 

During his long tenure, Dr. PincofTs organized the curriculum within a 
busy Department of Medicine, engaged in the practice of medicine and con- 
tributed greatly to the progressive development of the Medical School and 
enhanced its traditions through his teachings, investigations, writings and 
particularly by his leadership and maturity of judgment as an organizer and 
medical statesman. 

Much of his early career was devoted to investigations of the natural 
history of diseases, dealing in particular with physiologic phenomena related 
to the adrenal gland and hypertension, functional and structural abnormali- 
ties of the heart, disorders of the central nervous system, and clinical mani- 
festations and treatment of infectious diseases, particularly Rocky Mountain 
spotted fever. He is the gifted author of more than a hundred significant 
papers, editorials and other medical publications. 

It is difficult to express fitting tribute for his unselfish devotion, his depth 
of vision and his strength of character. Dr. PincofTs' accomplishments are a 
matter of record and one may merely glance at his curriculum vitac and 
bibliography to comprehend the vastness of his labors. The important medi- 
cal societies of the country are privileged to have him as a member. He is 
past president of the Maryland Medical and Chirurgical Faculty, the Ameri- 
can Clinical and Climatological Association, and the American College of 
Physicians, a post attained by few. Under his editorship since 1933, the 
circulation of The Annals of Internal Medicine has increased from about 
2,000 copies monthly to the number one position of all journals in Internal 
Medicine in North America, probably in the world, exceeding 21,500 
copies per month. 

During World War 11, Dr. Pincolls, in spite of his increasing years, held 
a high military post in the Pacific Theater of War, first as Commanding 
Officer of the -12nd General Hospital and later as Chief of Preventive Medi- 
cine. The presence of prominent members of the Armed Forces this evening 
attest to the esteem in which his contributions are valued. Following World 
War II, Dr. Pincoffs resumed his many academic responsibilities, yet he 
found time to provide patients with the same understanding and painstaking 
care so typical of the man. Since 1954. he has organized and fostered a new 
department devoted to the social and medical problems of the changing 
environment ani.1 focused attention on rehabilitation of the clironically ill. 



vi BLLLEIIS OF THE SCHOOL OF MEDICINE, U. OF MD. 

The medical problems of Baltimore and Maryland have received his 
tireless attention. For many years he has been a senior consultant to the 
State and City Health Departments rendering counsel and assisting in com- 
munity health matters with meticulous care and vision. Through his affilia- 
tion with the Maryland Medical and Chirurgical Faculty the profession and 
citizens ot the State have profited by his judgment and advice. Dr. Pincoffs 
was made Chairman of the Committee on Medical Care of the Maryland 
State Planning Commission, a program which is a pioneer project of its kind 
in the United States. 

Dr. PincofFs is one of Baltimore's foremost medical teachers, practi- 
tioners, and philosophers, whose mind and labors have shaped and have been 
shaped by an era of almost ceaseless medical progress. We could not salute a 
more worthy disciple of Aesculapius. 



MEDICAL SCHOOL SECTION 



Toastmaster 

Dr. W. Houston Toulson 

Professor of Urology, Emeritus 

School of Medicine, University of Maryland 



Invocation 

The Very Reverend John N. Peabody 
Dean and Rector of The Cathedral of Incarnation 



Greetings 

The Honorable Thomas D'Alesandro, Jr. 
Mayor of the City of Baltimore 

Dr. Wilson H. Elkins 

President 
University of Maryland 



Speakers 

Dr. Alan M. Chesney 

Dean Emeritus, School of Medicine 

The Johns Hopkins University 

Dr. Walter D. Wise 

Professor of Surgery, Emeritus 

School of Medicine, University of Maryland 

Dr. Theodore E. Woodward 
Professor of Medicine 
School of Medicine, University of Maryland 

Dr. William B. Kouwenhoven 

Professor of Electrical Engineering, Emeritus 

The Johns Hopkins University 

Presentation of Honors Unveiling of Portrait 



BL LLETI.X OF THE SCHOOL Of MEDILIXE, i. OF MD. 



Resident physicians who served during Dr. Pincoffs' 
tenure as Physician-in-Chief of the University Hospital 
and as Professor and Head of the Department of Medi- 
cine, School of Medicine, from 1922-1954. (From 1942 
to 1946 Dr. Pincoffs was on leave of absence for service 
in the Armed Forces during World War 11). 



UNIVERSITY HOSPITAL 

1922-23 Dr. Leon Freedom 

1923-24 Dr. Bricey M. Rhodes 

1924-25 Dr. William S. Love 

1925-26 Dr. Thomas A. Clawson 

1926-27 Dr. Edgar R. Miller 

1927-28 Dr. Frank F. Lusby 

1928-29 Dr. Charles E. Gill 

1929-30 Dr. Lewis P. Gundry 

1930-31 Dr. Benjamin H. Kendall 

1931-32 Dr. John H. Hornbaker 

1933-35 Dr. H. Vernon Langeluttig 

1935-37 Dr. Joseph H. Holmes 

1937-38 Dr. John A. Myers 

1938-39 Dr. Francis G. Dickey 

1939-40 Dr. Edward F. Cotter 

1940-41 Dr. John T. Atkins 

1941-42 Dr. Samuel T. R. Revell.Jr. 

1942-43 Dr- L. Harrell Pierce 

1943-44 Dr. W. H. Townshend, Jr. 

1944-45 Dr. M. Virginia Palmer 

1945-46 Dr. Alvin H. Honigman 

1946-47 Dr. H. Pearce MacCubbin 

1946-47 Dr. James R. Karns 

1947-48 Dr. Ernest G. Guy 

1948-49 Dr. William T. Raby 

1949-50 Dr. Robert E. Bauer 

1950-51 Dr. W. Carl Ebeling, III 

1951-52 Dr. John A. Hightower 

1952-53 Dr. Francis J. Borges 

1952-53 Dr. Kyle Y. Swisher 

1953-54 Dr. Howard F. Raskin 



MERCY HOSPITAL 

1923-24 Dr. H. Raymond Peters 

1924-25 Dr. Fred T. Kyper 

1925-26 Dr. F. B. Dart* 

1926-27 Dr. Thomas B. Turner 

1927-28 Dr. I. Sheldon Eastland 

1928-29 Dr. T. Nelson Carey 

1929-30 Dr. David Tenner* 

1930-32 Dr. Earl R. Chambers 

1932-34 Dr. J. Howard Burns 

1934-35 Dr. George H. Carr, Jr. 

1935-36 Dr. Philip D. Flynn 

1936-37 Dr. W. Grafton Hersperger 

1937-38 Dr. William H. Grenzer 

1938-39 Dr. John T. Atkins 

1939-40 Dr. S. Edwin Muller 

1940-41 Dr. Frederick J. Vollmer 

1941-42 Dr. William H. Kammer, Jr. 

1942-43 Dr. Donald 1. Roop 

1943-44 Dr. William" S. Lowe* 

1944-45 Dr. John R. Davis 

1945-46 Dr. J. Emmett Queen 

1946-47 Dr. Edward S. McCabe 

1947-48 Dr. Richard A. Carey 

1948-49 Dr. Joseph J. Bowen 

1949-50 Dr. Joseph F. LiPira 

1950-51 Dr. Thomas P. Connor 

1951-52 Dr. Howard F. Raskin 

1952-53 Dr. Charles R. Ireland 

1953-54 Dr. E. Paul Coffay, Jr. 

* Deceased 



MEDICAL SCHOOL SECTION ix 

Menu 
fresh grapefruit and strawberry cocktail supreme 

hearts of salted mixed 

celery almonds olives 

consomme a la bellevue en tasse 

cheese straws 

lobster a la newburg 

champagne 

roast prime ribs of beef au jus 

new boiled potato fresh jumbo asparagus 

parsley and butter polonaise 

chef's salad 
russian and roquefort cheese dressing 

coupe au marron 

petit fours 

coffee mints 

Dinner and Celebration Committee 

T. Nelson Carey 

j. Sheldon Eastland 

John C. Krantz, Jr. 

Ephraim T. Lisansky 

James T. Marsh 

William T. Raby 

Harry M. Robinson, Jr. 

Samuel T. R. Revell, Jr. 

George H. Yeager 

Theodore E. Woodward, Chairman 



X BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

DIVISION OF DERMATOLOGY 

Dr. John F. Strahan, who has recently completed his residency training in derma- 
tology' at the School of Medicine, University of Maryland, has been certified for the 
practice of this specialty by the American Board of Dermatologists, and has opened 
offices at 1117 St. Paul Street in Baltimore. 

Dr. Raymond C. V. Robinson, assistant professor of dermatology, has been named 
assistant chief of the dermatology clinic at the School of Medicine. In association 
with Dr. Harry ]M. Robinson, Jr. and Dr. John F. Strahan; Dr. Robinson has pre- 
sented an exhibit entitled "Control of Emotional Pictures in Dermatology" at the 
recent meeting of the American ^Medical Association held in New York. 

Dr. Harry ]\I. Robinson, Jr., professor of dermatology and Dr. Francis A. 
Ellis, associate professor of dermatology, will attend the meeting of the Eleventh 
International Congress of Dermatology to be held in Stockholm July 31st-August 
5th, 1957. 

NEW LABORATORY PLANNED 

At present, the Division of Dermatology plans to establish a new laboratory in 
the clinic which will be furnished with funds obtained by clinical investigation in 
the Division. 

:\IED1CAL SCHOOL HOST TO AAIERICAN ASSOCIATION 
OF ANATOMISTS 

The School of Medicine was host to the Seventieth Annual Session of the American 
Association of Anatomists held in Baltimore April 17-19, 1957. The General Chair- 
man of the Committee was Dr. Frank H. J. Figge, Professor of Anatomy, who was 
assisted by members of his department and many members of the student body. 

High lighting the program were a large number of scientific and technical exhibits 
as well as numerous scientific contributions which received national mention in 
the press and in scientific journals. "Old secret dissecting rooms" were reopened in 
the style of the early 19th century with students in participation, actually dissecting 
cadavers preserved in whiskey as was the custom then. The old spiral staircase in the 
northeast corner of the old medical building was reopened and used as a ''secret" 
passageway to the hidden dissecting room. Other historic elements of the school were 
on display. 

DR. WAGNER VISITS GEORGIA MEDICAL GROUP 

Dr. John A. Wagner, Professor of Neuropathology, was a recent speaker at the 
meeting of the Richmond County Medical Society in Augusta, Georgia. 

DR. FRANCIS BORGES ADDRESSES HIGH SCHOOL STUDENTS 

Dr. Francis J. Borges, Associate in Medicine at the School of Medicine, recently 
spoke on "Medicine and the Career" at the Career Day program held at the Catons- 
ville Junior High School on March 7. 



MEDIC A L SCHOOL SECTION xi 

DR. SAVAGE ACTIVE AT NEW ORLEANS (GRADUATE 

MEDICAL ASSEMBLY 

At the Twentieth Annual Meeting of The New Orleans Graduate Medical As- 
sembly held at the Munic ipal Auditorium, New Orleans, La., cjn March H 14, 1957, 
Dr. John E. Savage, Class of 19,^2, and Assistant Professor of Obstetrics and Gyne- 
cology, was the si)eaker on obstetrics. He presented the following papers: "Vaginal 
Breech Delivery," "Lacerations of the Birth Canal," and "Hemorrhage of Late 
Pregnancy." Dr. Savage also read a paper entitled, "An Account of the Early History 
of Cesarean Sec tion in the United States," before a meeting of The Xew Orleans 
(iynecwiogical and Obstetrical Society. 

DEPARTMENT OF MEJ;U INE NOTES 

Miss Anne E. Rifler, of the Department of Medicine, has been awarded the J. 
Howard Hrowii .Memorial Award at Camp Delrick, Maryland. This award is given 
annually to the outstanding student bacteriologist in the State of ^Maryland. Miss 
Rider, a graduate of Notre Dame College of Maryland, was cited for her studies on 
the effect of ultraviolet radiati(jn on the growth cycle of bacteria. Miss Rider is cur- 
rently engaged in metabolic studies on Serotonin and is associated with the Division 
of Hy{)ertension of the Department of Medicine. 

MLSS WYAT'J^ RETIRES 

After 27 years of devoted service as operator of the central switchboard for 
The Baltimore Schools, Miss Lillian R. W'yatt retired on January 31, 1956. Miss 
W'yatt came to the University in 1930 as operator of the small manually operated 
switchboard controlling a relatively small number of telephones. During the inter- 
vening years she has witnessed the switchboard grow to a huge dial-controlled system 
handling nearly a thousand incoming and outgoing calls, thousands of inside calls, 
and scores of long distance calls every day. Miss W'yatt will be succeeded by Mrs. 
\'era Martin as Chief Operator. 

Miss Wyatt will continue to live at her ai)artment at 713 Park Avenue, Baltimore. 
Her plans for the future include a trip to California and greater participation in local 
and civic activities. She also plans, if time permits, to gather material for a book of 
Reminiscences of The University of Maryland. Her many friends at The University 
of Maryland wish her continuing hai)piness in the years ahead and much success in 
all her activities. 

MERCY HOSPITAL NEWS 

Dr. Henry J. .Marriott, author of the popular text "Practical Electrocardiog- 
raphy", has announced a second edition of his book which will appear in .August, 
1957. 

Dr. J. Sheldon Eastland, a member of the X'isiting Staff and Associate Professor 
of Medicine, was recently elected President of the Medical and Chirurgical Faculty 
of the State of Marvland. 



xii BULLET IS OF THE SCHOOL OF MEDICISE, U. OF MD. 

RADIOLOGY COURSE APPROVED 

The American Board of Radiology has announced the approval of the training 
program in radiology at Mercy Hospital for a two year course. The first and third 
year will be spent in residency at Mercy with the second year devoted to radiation 
therapy under the direction of Dr. Fernando Bloedorn at the University Hospital. 

INTRODUCING NEW MEMBERS OF THE FACULTY 
MARTIX HELRICH, M.D. 

Dr. Helrich, recently appointed Professor and Chairman of the Department of 
Anesthesiologv, received his B.S. at Dickinson College and his M.D. at the Univer- 




Martin Ilelrich, M.D. 

sity of Pennsylvania in 1946. He interned at the Atlantic City Hospital and served 
a residency and fellowship in Anesthesiology at the Bellevue Medical Center. 

During his military service he was chief of Anesthesiology of the U. S. Army 
Hospital at Camp Polk, Louisiana. He was appointed Assistant Professor of Anes- 
thesiology of the University of Pennsylvania Medical School. 

Dr. Helrich has done extensive research in several fields of Anesthesiology includ- 
ing the distribution of intrathecal procaine, the effects of inhalation anesthesia on 
the circulation, and the respiratory effect of opiates and opiate antagonists. These 
investigations are reported in fifteen scientific papers. 

He is a member of Phi Beta Kappa and Sigma Xi and a number of professional 
societies including the American Society of .Anesthesiologists, American College of 
Anesthesiologists, American Board of Anesthesiology, and Association of University 
Anesthetists. 

ROBERT E. BAUER, ^LI). 

Dr. Robert E. Bauer has recently returned to the University Hospital after serving 
with the Armed Forces and is presently Codirector of the Radioisotope Laboratory. 



MEDICAL SCHOOL SECTION 




Robert E. Bauer, M.D. 

Dr. Bauer received his Bachelors degree from Johns Hopkins University in 1943 
and his M.D. at the University of Maryland in 1946. 

He served his internship and residency at the University of Maryland and was 
chief resident in ^Medicine from 1949 to 1950. He held a fellowship at the Oak Ridge 
Institute of Nuclear Studies in 1950. 

Dr. Bauer has been associated with the University of Maryland Medical School 
as Instructor and Assistant Professor of ?^Iedicine since 1950. 

We welcome him back to our active faculty. 

JEROME K. MERLIS, M.D. 
Dr. Jerome K. ]Merlis has joined the faculty as Professor and Head of the Depart- 
ment of Neurophysiology and Director of the Department of Electroencephalog- 
raphy. 




Jerome A. Mcrlis, M.D. 

He was educated at the I'niversity of Louisville, receiving his B.S. in 1933, M.D. in 
1937 and an M.S. in jihysiology in 1938. 

Dr. Merlis was Seymour Uoman Fellow in Physiology at the University of Chicago 



xiv BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

in 1938, and the Commonwealth Fund Fellow in Neurophysiology at the Yale 
University, 1940-41. 

Following his military service, he was instructor and Assistant Professor of Neuro- 
physiology at the University of Louisville and then served as Instructor in Neurology 
at Harvard University, 1954-56. 

He was certified by the American Board of Psychiatry and Neurology, and by 
the Board of Qualifications, American EEG Society. 

He is a member of numerous professional societies, having served in a national 
executive capacity in the American EEG Society, American League Against Epi- 
lepsy and Eastern Association of EEG. 

Dr. Merlis is currently editor of Epilepsia, and is the author of more than twenty- 
five articles in the field of neurophysiology. In his research he has contributed ex- 
tensively to the understanding of the role of the motor cortex in myoclonus. 

FACULTY AND :\IE.MBERS OF DEPARTMENT OF OTOLARYNGOLOGY 
ACTIVE IN INTERNATIONAL CONGRESS 

The Sixth International Congress of Otolaryngology w^as held in Baltimore on 
Saturday, May 11, 1957. jSIembers of the committee in charge of arrangements in- 
cluded Dr. Thomas R. O'Rourk, Professor of Otolaryngology. IMembers of the Fac- 
ulty participating in the program included Dr. Robert Buxton who spoke on "Salivary 
Gland Tumors" and Dr. Vernon E. Krahl who spoke on "Anatomy of the Terminal 
Airways". 

DR. HOCH PHI DELTA EPSILON LECTURER 

Dr. Paul Hoch, Commissioner of Mental Hygiene of New York State, was the 
annual Phi Delta Epsilon lecturer. Dr. Hoch, who spoke on "The Use and Abuse of 
Tranquilizing Drugs" addressed the School of Medicine on March 22, 1957. His 
address was discussed by Dr. Jerome Frank, Professor of Psychiatry at the Johns 
Hopkins University and Dr. John C. Krantz, Jr., Professor of Pharmacology in the 
School of Medicine. 

MEDICAL LIBRARY NOTES 

The following persons gave books and journals to the library between February 1 
and May 1, 1957: 

Dr. Tibor Benedek Dr. Samuel Glick 

Dr. C. S. Bluemel Dr. Frank W. Hachtel 

Dr. Louis V. Blum Hynson, Westcott, and Dunning 

Dr. J. Edmund Bradley Dr. Arthur M. Kraut 

:Miss Pearl Chan Mr. Harry M. Miller 

In memory of Mrs. William R. Quynn 

Dr. Howard L. Zupnik Dr. William S. Stone 

Dr. A. Estin Comarr U. S. Food and Drug Administration 
Dr. Ernest I. Cornbrooks, Jr. Dr. Charles L. Wisseman, Jr. 



MEDICAL SCHOOL SECTION xv 

There is gratifying evidence that alumni in different parts of the country are fol- 
lowing with interest the progress reports on the new library building. Excerpts follow 
from letters sent to the librarian. 

Dr. Arthur M. Kraut of Newark, New Jersey (class of 1923) wrote: "I am anx- 
iously awaiting the starting of the new library. . . . Will it be possible to plan for 
'dedications' for different sections of the library -as memorials . . . and to have 
donations made for purchases, acquisitions, etc.? If that could be planned for, per- 
haps certain sums could be acquired — they need not be large — and a little 'elbow 
room' as far as money is concerned be allowed for such purposes as you may see 
fit." 

From Concord, North Carolina, Dr. A. Frank Thompson, Jr. (class of 1940) 
wrote: "I am most interested in plans for a new Library and have followed the plans 
as set forth in the Medical School Bulletin. ... I am a little disappointed that the 
interested alumni have not been asked to lend their support. I do think that many 
would be interested in providing some of the needed 'things' in the new library. . . 
to the extent at least of modest contributions." 



•3 erving the Medical Profession 
for over a third of a century 



Equipment ana Supplies for: 

Pnysicians ana Surgeons * HoBpitals 

Laooratories * Industrial Clinics 



W 



.Murray- jBaumgartner 

SURGICAL INSTRUMENT COMPANY, INC. 

5 West Ckase Street • SArato^a 7-7333 
Baltimore L Marylana 



Anuoiincement 

THE TENTH ANNUAL 

DOCTOR JULIUS FRIEDENWALD 

MEMORIAL LECTURE 

Will Be Give?2 By 

Doctor Waltman Walters 
of The Mayo Clinic. 

on 

THURSDAY, OCTOBER 17th, 1957 

at the 

UNIX'ERSITY OF MARYLAND, SCHOOL OF MEDICINE 

CHEMICAL HALL--MAIN BUILDING 

N.E. COR. LOMBARD AND GREEN STS. • BALTIMORE 

Doctor Waltman Walters topic ivill be, 

''thirty YEARS EXPERIENCE IN 

THE TREATMENT OF BILIARY TRACT LESIONs" . 



ABSTR.\CTS 

Topical Steroid Therapy ix the Management of Occupational Dermatoses.* 

Robinson, Harry M., Jr., Baltimore 1, Maryland. 

Occupational dermatoses have been defined by various industrial accident com- 
missions as "due to or aggravated by the individual's occupation." In recent years 
the introduction of resins, detergents, and other sensitizing or primary irritating ma- 
terials into industry has added to the problem so that at present skin eruptions con- 
stitute 60 percent of all medical diseases reported to the compensation boards in 
the United States. In many instances it is not possible to prove or disprove the rela- 
tionship of the dermatosis to the patient's occupation if the suspected agent is a 
primary irritant such as soaj), a detergent or a volatile solvent. In such instances the 
Compensation Board issues a ruling in favor of the patient and the insurance com- 
pany or the patient's employer must bear the expense of medical care and also reim- 
burse the individual for time lost from work. 

In the strict literal sense, the term "occupational dermatosis" is limited primarily 
to an eruption which has developed during the course of work for which the patient 
receives compensation. In recent years, as a result of the development of various 
household cleansing agents known as detergents, the incidence of primary' irritation 
dermatitis and allergic contact dermatitis in housewives has increased to an alarming 
degree. Furniture polish, solvents and some cleansing agents have also been con- 
tributing factors. 

Topical steroid therapy has proved to be of definite value in the management of 
atopic dermatitis, dermatitis venenata, seborrheic dermatitis, intertrigo, pruritus 
ani, pruritus vulvae, lichen simplex chronicus and eczematous eruptions of the 
hands (1-llj. The introduction of topical steroid therapy for the treatment of 
eczematous eruptions has been a valuable asset in the management of some derma- 
toses attributed to occupations. In many instances local applications of steroids in 
suitable vehicles have accelerated the involution of lesions, or have so improved the 
condition that the patient may perform some gainful occupation while under treat- 
ment. 

(To Be Published.) 

Studies ox Human Infection With Pasteurella Tidarensis. I. Comparison of 
Streptomycin and Chloramphenicol in the Prophylaxis of Clinical Disease. f 
McCrumb, Fred R., Jr., Snyder, Merrill J. (By Invitation) and Woodward, Theo- 
dore E., Baltimore 1, Maryland. 

Human volunteers have been infected by the intradermal inoculation of the Rector 
strain of Pasleurclla tidarensis for the purpose of investigating the pathogenesis, 
mechanism of immunity and the effect of antibiotics on tularemic infections in man. 
X'ariation of inoiula from 50 to 50,000 mouse LDsn has revealed that the minimal 
infective intradermal dose of the Rector strain for man is about 1(K) mouse LD50. 

* F"rom the Department of Dermatology, School of Medicine, University of Mar>'land. 
t From the Department of Medicine, School of Medicine, University of Maryland. 



xviii BULLET IX OF THE SCHOOL OF MEDICINE, U. OF MD. 

Streptomycin, when administered soon after inoculation of the viable bacteria, 
successfully eradicated the infection after five days of therapy. Clinically overt illness 
was fully suppressed, the local dermal lesion failed to develop and the agglutinin 
response was negligible when patients were given streptomycin prophylactically. 

Chloramphenicol did not eradicate P. tularensis from the site of inoculation and, 
following suppression during the period of prophylaxis, clinically manifest illness 
characterized by fever, dermal lesion and bubo appeared. Agglutinins could be 
demonstrated only in patients who developed overt disease. This study in 35 volun- 
teers suggests a difference in the mode of action of streptomycin and chloramphenicol 
in tularemic infection in man. 

(To Be Published) 

M.^ix Stem Extrasystoles.|J§ ByHenr>- J. L. Marriott, B.M., B. Ch. (O.xon) Asso- 
ciate Professor of Medicine, University of Maryland School of Medicine; Chief, 
Electrocardiograph Department, Mercy Hospital and Samuel M. Bradley, INI.D., 
Assistant Resident in Medicine, Mercy Hospital. 

Extrasystoles arising in the main stem of the h bundle of His are generally regarded 
as very rare; only seven examples have been published since their original description 
by Lewis in 1911 and two of these fail to satisfy rigid criteria for diagnosis. Four fur- 
ther examples, encountered in a relatively small series of tracings, are here pre- 
sented and it is concluded that such extrasystoles are not so much rare as they are 
overlooked. 

Ax Alarmixg Pressor Reactiox to Regitixe* 

The intravenous administration of Regitine is generally regarded as safe. In the 
course of a routine hypertensive work-up in a patient with severe essential hyper- 
tension, the intravenous injection of 5 mg. Regitine was followed by an alarming 
reaction consisting of marked rise in blood pressure from 270/128 to 300-J-/185, 
tachycardia to 156, pulsus alternans, profuse sweating and severe precordial pain. 
The possibility that a pressor substance had been injected by mistake was excluded. 

Thyroiditis: A Review axd Presextatiox of Forty Pathologically Proved 
Cases of Chroxic Thyroiditis. (Accepted for Publication by Southern IMedical 
Journal— Dec. 1956) f J 

Although chronic thyroiditis is not considered a common disease, 40 proved cases 
were seen and studied at the University Hospital, Baltimore, ^Maryland during the 

li This manuscript has been accepted for publication by Circulation. 

§ From the Department of Medicine, School of Medicine, University of Maryland and the Mercy 
Hospital, Baltimore, Maryland. 

* Henry J. L. Marriott, M.D., Associate Professor of Medicine, University of Maryland; Chief, 
Electrocardiogra])h Department, Mercy Hospital, Baltimore, Maryland. .Vccepted for publication 
in Annals of Internal Medicine. 

t Yeager, George H., Workman, Joseph B., Holbrook, William M., and Patten, David H. From 
Departments of Surgery and Medicine, School of Medicine, University of Marjdand, Baltimore, 
Maryland. 

X Presented, in part, as the Chairman's .\ddress, Section on Surgery, Golden Anniversarj' Meet- 
ing, Southern Medical Association, Washington, D. C, November 13, 1956. 



ABSTRACTS xix 

four year period, 1952-56. Selection of {)alienls required not only a positive patho- 
logic diagnosis of chronic thyroiditis but the performance of at least two of the four 
more common laboratory indices of thyroid function, i.e., BMR, PBI, serum cho- 
lesterol, and radioactive iodine tracer test. 

In general, the well documented features concerning chronic thyroiditis were 
j)resent in the group studied, i.e., preponderance of middle aged white females, 
history of recent thyroid enlargement and a wide range of symptomatology. Hypo- 
metabolism was indicated to be present in 80 per cent of patients if laboratory tests 
of thyroid function were considered alone. 

Scintography, the mapping of functioning areas of the thyroid gland using tracer 
doses of radioiodine and a specially designed scintillation counter was performed 
preoperatively in 50 per cent of the patients. Eighty per cent of the scintigrams dis- 
closed areas of decreased function in keeping with hypofunctioning thyroid tissue. 

Pathologically, 37 (94 per cent) of the patients were classed as Hashimoto's disease 
and 3 (6 per cent) as Riedel's Struma. In 4 patients (10 per cent) thyroid carcinoma 
and Hashimoto's disease were found to co-exist within the same gland. For this 
reason, bilateral subtotal thyroidectomy with adequate exposure and biopsy of 
suspicious areas within the gland, at the time of surgery, would appear to be the 
therapy of choice in chronic thyroiditis. 



OBTAIN YOUR COALME.MORATIVE :\IEDAL NOW 





The Medical Alumni Association can still ofifer a few of the line, registered medals 

struck in commemoration of the 150th Anniversary of the School of Medicine. 

These may be obtained by writing the Medical Alumni Association. Lombard and 

Greene Streets, Baltimore 1, Maryland. Price is as follows: 
Bronze — S3.00 plus S.06 ^Maryland State Sales Tax (where applicable) 
All medals will be sent postpaid upon receipt of remittance. Fifty cents should be 

added to the above prices if the purchaser desires the order to be registered or insured. 



POST GRADUATE COMMITTEE SECTION 

POST GRADUATE COMMITTEE, SCHOOL OF MEDICINE 



HOWARD M. BUBERT, M.D., Chairman and Director 
Elizabeth Carroll, Executive Secretary 

Post Graduate Office: Room 201 

Old Medical Building, Lombard and Greene Streets 

Baltimore 1, Maryland 

THE CARIBBEAN CRUISE 

The Postgraduate Committee has arranged for a medical cruise to the Caribbean 
in the fall of 1957. The cruise ship will sail from Wilmington, North Carolina, on 
Saturday, November 30th and return to Wilmington the following Friday, Decem- 
ber 6th. 

The American Academy of General Practice will allow 15 hours of Category I 
Credit for the lectures that will be given during the cruise. 

The ship will stop over for one day at Nassau and one day at Havana. There will 
be the usual attractions of shipboard life and it is hoped that you will keep the cruise 
in mind when arranging for your yearly vacation. ^Nlany of your friends will be on 
board. Why not join them? For further information, please contact Mrs. Carroll in 
the Postgraduate Office. 

TV-MD 

T\'-MD, The LTniversity's medical program over WBAL-T\', will begin its seventh 
consecutive year of telecasting in the fall. Please watch your newspapers for the 
date and time. 

BASIC SCIENCE COURSE 

The Committee is happy to announce that the Basic Science Course this year has 
been unusually well attended. It is very gratifying to the Committee that so many 
came so far for such an e.xtended period of time. 

CALENDAR OF EVENl'S 

Recognizing the need for a regular listing of special activities of the departments 
of both the Hospital and the School of Medicine, as well as noting principal routine 
schedules in the Hospital and School, the Postgraduate Committee inaugurated the 
publishing of a Calendar of Events. With but few brief interruptions because of cir- 
cumstances beyond the control of the Committee, the Calendar has been j)ublished 
weekly since March 4, 1956. That the publication has been worth while is attested to 
by the fact that the circulation has grown from about 110 copies when tirst distrib- 
uted to approximately 215 copies. Hardly a week goes by without requests for addi- 



POST GRADUATE COMMITTEE SECTION xxi 

tional copies by men who find the material useful — whether to attend a special 
lecture in their particular field or to keep informed as to what is going on on the 
Haltimore Campus. 

The Committee deeply appreciates the cooperation of the various dei)artments and 
especially their hard-pressed secretaries, for sending us material in time for publica- 
tion dead-line. Unhappily for all concerned, many times material is received too late. 
However, when there is insuflicient time to mail the material to the Postgraduate 
Committee Otlice, it may be telephoned by calling Plaza 2-1100, Extension 259, and 
the information will receive the special attention of the secretary in charge of the 
publication. 



Single Copies of 
Bulletin are Available 



Back numbers of many volumes of the Bulletin of the 
School of Medicine are available. 

An inquiry will be promptlv acknowledged. Copies in 
stock can be purchased at 32.00 per volume (single 
copies S.50) as long as thev last. All issues postpaid. 

Address 

Bulletin of the School of Medicine 
University of Maryland 
Lombard (S: Greene Sts. 
Baltimore i, Maryland 



ALUMNI ASSOCIATION SECTION 

OFFICERS* 

J. Sheldon Eastland, M.D., President 
WiLLWM B. Long, M.D., President-elect 

Vice-Presidents 

A. Harry Finkelstein, M.D. Arthir Siwixski, M.D. Martin Strobel, M.D. 

Edwin H. Stewart, Jr., M.D., Secretary Ernest I. Cornbrooks, Jr., M.D.. Treasurer 

J. Emmett Queen, M.D., Assistant Secretary Mi.vette E. Scott, Executive Secretary 

\ViLLi.\M H. Triplett, M.D., Director 



Board of Directors 
J. Morris Reese, M.U., 

Chairman 
J. Sheldon Eastland, M.D. 
Ernest I. Cornbrooks, Jr., M.D. 
Edwin H. Stewart, Jr., M.D 
Simon Br,\ger, M.D. 
Frank N. Ogden, M.D. 
H. Boyd Wyue, M.D. 
J. Emmett Queen, M.D. 
Gibson J. Wells, M.D. 
William H. Triplett, M.D. 
William B. Long, M.D. 



Nominating Committee 
Emanuel Schimunek, M.D., 
Chairman 
Dexter L. Reimann, ALD. 
Edwin S. Muller, ^LD. 
J. Howard Franz, M.D. 
Howard B. Mays, M.D. 



Representatives to General 
Alumni Board 
William H. Triplett, ^LD. 
Thurston R. Adams, M.D. 
Daniel J. Pessagno, M.D. 



Library Committee 
Milton S. S.\cks, M.D. 

Representatives. Editorial Board. 

Bulletin 

Harry C. Hull, M.D. 

Albert E. Goldstein, M.D. 

J. Sheldon Eastlant), M.D. 

(ex-officio) 

Representatives, Advisory Board, 

Faculty 

William H. Triplett, M.D. 

Albert E. Goldstein, M.D. 

Edwin H. Stewart, M.D. 



DE.\N'S LETTER 
Dear Members of the Alumni and Friends of the Medical School : 

During the past year I have indicated to you that the faculty has been working to 
revise the By-laws of the School of Medicine. The new By-laws developed by the 
faculty of the School of ^Medicine have now been formally approved by the University 
Senate and were put into eflfect on November 21, 1956. 

The new By-laws provide for a more democratic form of faculty government. 
There is a more positive provision for representation from the part-time faculty in 
the Faculty Board. The Faculty Board has a greater role in determining medical 
school policy. The By-laws of the School of ]\Iedicine are in keeping with the stipula- 
tions of the University By-laws and faculty government. Lines of administration and 
policy are more clearly defined. 

In a similar manner, student government has been organized by the students and 
the relationships with the administration and faculty clearly detined. Under the 
Associate Dean for Student Affairs, Dr. Dietrich C. Smith and the Faculty Student 
Advisory Council, the students are taking an active part in University affairs as well 
as developing and regulating student activities. It is expected that as a result of 
student and faculty action, the honor system will be initiated in ihe medical school 
in the very near future. 

The faculty graduate committee has been reconstituted under the chairmanship 
of Dr. Frederick P. Ferguson, who also represents the medical school on the Univer- 
sity's graduate council. The Graduate Committee will attempt to improve the op- 
portunities for graduate work in the medical school. It is expected that graduate work 



.1 IJMXI ASSOC/ A TIOX SFITIOX xxiii 

will not only be j)roviclecl in the medical basic sciences as in ihe past, bui will also 
include work in the clinical fields as well. With the research ])rograms now under way 
in Pediatrics, Internal Medicine, Psychiatry, Surgery, Radiology and Anesthesiology, 
there are many opportunities for graduate work in c linical medicine. It is expected 
that following graduation, increasing numbers of medical students will choose grad- 
uate work in preparation for research and teaching careers in medicine. 

The Medical School's research program is growing rapidly. We find that many of 
our students are disi)laying a real interest in research. They are being encouraged 
by the faculty and we now have undergraduates in medicine doing research by par- 
ticipating in faculty research projects and short term ])art-time projects of their own 
during the summer and in unscheduled time. 

At the meeting of the Association of American Medical Colleges during November, 
1956, it was brought out that if American medicine is to meet the needs of the United 
States population that by 1970 there would be a need for 31 additional medical 
schools or their equivalent through enlarging the enrollment of existing schools. 

The School of ]\Iedicine is in a phase of development and growth. There is great 
need for better understanding and support for our needs for a better and larger 
physical plant so that primary teaching demonstrations of clinical medicine can be 
carried out in our own hospitals and clinics under adequate faculty supervision and 
direction. With the great amount of information now available in medicine, basic 
teaching should not be handicapped by losing one to two hours daily due to the 
present necessity of students traveling to several hospitals for demonstrations of 
clinical problems and to gain experience covering the various specialty fields in 
medicine. 

Sincerely, 

^^'II.LIAM S. Stone, M.D., De.\n 

TO THE BI-CENTENNIAL OF THE SCHOOL OF MEDICINE— 

A CHALLENGE 

As the Medical Alumni Association celebrates the recurring reunions of the gradu- 
ating classes, it has been repeatedly shown that 15 per cent of the alumni of the School 
of Mediiine are still in active practice 50 years after graduation. The following pic- 
tures include ap{)roximateK- 20 doctors who will be [)resent for the bi-centennial 
celebration (we hope) which will be held presumably on June 6, 2007. 

The sesquicentennial class of 1957 has kindly posed for its picture and recorded 
itself as being unanimously in favor of complete participation in the bi-centennial 
celebration. However, none of the class has indicated the degree to which he will 
challenge the inevitable 20 per cent survival figure which has prevailed in the past. 

As a challenge to members of the class of 1957 and as an exercise in far reaching 
vision and in prediction of things to come, it is suggested that those members who 
will be present on the campus June 6, 2007, so indicate. ]May improved research 
and progressive discoveries in medicine; a lengthening life span and good health 
ojjcrate to the extent that many more of the class of 1957 shall be present at their 50 
year reunion than has been possible in the past. 



BULLRTIX OF THE SCHOOL OF MFDICINE, V. OF .\fD. 







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— - 'VI X 



BULLET IX OF THE SCHOOL OF M EDICT XE. C . OF MD. 




ALLMXI ASSOCIATIOX SECTIOX xxvii 

DR. THOMAS B. TURNER NAMED HOPKINS DEAN 

Alumxus of Class of 1925 to Assume Important ADMr\isTRATi\K Post 

Dr. Thomas B. Turner, a member of the class of 1925, and currently Professor of 
Microbiology at the School of Hygiene and Public Health of the Johns Hopkins 
University, has recently been named Dean of the Johns Hopkins School of Medicine 
in an appointment announced by Dr. Milton S. Eisenhower. 





Dr. Thom.\s B. Turner 

Dr. Turner, who will assume office on July 1, will succeed Dr. Philip Bard, the 
present Dean and former Professor of Physiology. Dr. Bard will return to full time 
leaching in physiology. 

.\ graduate of St. John's College in Annapolis, and of the University of Maryland 
School of Medicine in 1925, Dr. Turner served his internship at the Hospital for 
Women of Maryland and was later resident in medicine at Mercy Hospital. This was 
followed by a two year Fellowship in Medicine at the Johns Hoj^kins Hospital from 
1927 through 1929. He was then successively instructor and associate in medicine 
until 1932 when he became a member of the staff of the Rockefeller Foundation's 
International Health Division. Dr. Turner has long been identified with the National 
Foundation for Infantile Paralysis, World Health Organization and many other 
national committees. 

.MAkVLAXI) ALUMNI MEET DURING NORTH CAROLINA ST.\TE 
.MEDICAL SOCIETY MEETIN(; 

On Monday evening. May 6, 1957, a grou]) of Maryland alumni and their ladies 
assembled at the Battery Park Hotel, Asheville, North Carolina for cocktails and 
dinner. The Medical Society of the State of North Carolina being then and there in 
session, provided the opportunity for the get-together. 

Dr. William S. Stone, Dean of the School of Medicine and Dr. William H. Triplett, 
Director of the Medical .Alumni .Association were guests. Dr. Stone gave the group 



xxviii BILLETIX OF THE SCHOOL OF MEDICIXE, V. OF MD. 

a brief resume of events and developments, both accomplished and projected on the 
campus at Lombard and Greene. 

At the conclusion of the dinner, a short business meeting was held and Dr. Leon 
H. Feldman, class of 1934, elected Chairman of a committee to plan for a similar 
assembly during the State meeting in 1958. 

Dr. J. B. Anderson, class of 1935, deser\'es a solid vote of thanks for his services as 
Chairman in arranging and developing such an enjoyable program. 

The following alumni and their ladies attended the dinner: Dr. and Mrs. J. B. 
Anderson, Asheville; Dr. and Mrs. H. E. Barnes, Hickor\-; Dr. A. M. Diggs, Hunters- 
ville; Dr. and Mrs. William X. CorjDening, Granite Falls; Dr. and Mrs. O. D. Evans, 
Jr., Charlotte; Dr. and Mrs. Leon H. Feldman, Asheville; Dr. Albert G. Hahn, 
HickoPk'; Dr. and Mrs. Henderson Invin, Eureka; Dr. Joseph C. Knox. Wilmington; 
Dr. and Mrs. Joseph F. McGowan; Dr. Frank S. Parrott, Salisbur}-; Dr. James S. 
Phelps, Jr., Troy; Dr. F. G. Prather and Mrs. Armentrout, Asheville; Dr. William 
T. Raby, Charlotte; Dr. J. T. Sutton, Scotland Xec; Dr. and Mrs. J. Paul Young, 
Ashe\-ille; Dr. Ben Gold, Shelby; Dr. Weldon Chandler. Weaverxnlle; Dr. WiHiam 
S. Stone and Dr. William H. Triplet! of Baltimore. 

DR. SCHM.\LE HONORED 

Dr. Arthur H. Schmale, Jr., Class of 1951 and Instructor in Ps3'chiatr\- and Medi- 
cine, at the University of Rochester, has recently been awarded a John and Mary 
R. Markle Foundation grant for a period of 5 years. He is one of IS ^Nlarkle Scholars 
in ^ledical Science chosen from 57 candidates nominated by medical school deans 
in the United States and Canada, each of whom presented a five-year program for 
intellectual and research development. 

The purpose of the Markle program is to aid young medical school faculty members 
seeking careers in teaching and research and to relieve the shortage of teachers in 
medical schools as well as to strengthen their faculties by encouraging young scien- 
tists to remain in academic medicine. The program was begun 10 years ago and during 
its development has given grants totaling over 86,000,000 to some 206 doctors in 
some 74 medical schools throughout the United States and Canada. 

.\x OLD alu:mxus writes 

Uni Malaga Ave- 
Coral Gables. Fla. 
May 11. 1957 

University of Mar}-land Medical School 

Alumni Department 

Dear Sirs: 

I regret that I am unable to attend the meetings of the Alumni Association and the 
banquet at the Lord Baltimore Hotel on June 6, 1957. 
Ver>' Best for the Great and Old Medical School. 

Sincerely, 

Eugene H. Mullax. M.D. 
1903 



ALl'MXI ASSOCIATION SECTIOX xxix 

ITEMS 

Dr. Albert B. Kump, class of 1938, was honored by the Cumberland County Med- 
ical Society of the Stale of New Jersey at a reception held on Sunday, April 28, 1957, 
at the Haddon Hall Hotel in Atlantic City. 

Dr. I. Phillips Frohman, class of 1937, has written an article entitled "Are Physi- 
cians Educated?". This has been published in the Oklahoma State Medical Associa- 
tion Journal, March 1957. In a very well written and concise article Dr. Frohman 
makes a plea for continued, broad education in the humanities as a prerequisite of 
being a good doctor and a good citizen. 

Dr. W. Kenneth Mansfield, class of 1936, has recently announced the removal of 
his office for the practice of obstetrics and gynecology from 44 West Biddle Street to 
2 East Read Street in Baltimore. 

Dr. Henry F. Ullrich, class of 1929, has announced the association of Dr. John E. 
Carroll, Jr., class of 1952, in the practice of orthopedic surgery with ofBces at 715 
Park Avenue, in Baltimore. 

Dr. H. Elias Diamond, class of 1926, took part in a panel discussion on atomic der- 
matitis at the Academy of Allergy meeting (Post Graduate Course) in Los Angeles, 
California on February 3, 1957. 

Three Baltimore doctors. Dr. Herman Seidel, P & S, class of 1910, Dr. Benjamin 
Kader, class of 1910, and Dr. Joseph Kemler, class of 1907, were given the 50 year 
award for membership in the Phi Delta Epsilon National ^Medical Fraternity. The 
occasion was a dinner at the Woodholme Club sponsored by the 4th District Con- 
clave of Baltimore, Washington and Richmond Schools. The toastmaster was Dr. 
Harry Cohen, President of the Baltimore Chapter of the Fraternity. Three of the 
past presidents, all graduates of the University of Maryland School of Medicine were 
I)resent, Drs. Israel Zinberg, David Silberman and Shipley Glick. Dr. Seidel, who 
visited Israel in 1955, was instrumental in founding the Herman Seidel Medical 
Center at Yaflfa, Israel. 

DR. TRUSS APPOINTED TO IMPORTANT MEDICAL POST 

Dr. William G. Thuss, Jr., class of 1948, has recently been appointed the first 
associate professor of industrial medicine in the Department of Preventive Medicine 
and Public Health, University of Alabama Medical College. 

A native of Birmingham, Alabama, Dr. Thuss received the Doctor of Science de- 
gree in industrial medicine from the University of Cincinnati in 1956. He is also medi- 
cal director of Hayes .\ircraft Corporation in Birmingham and is in practice with the 
Thuss Clinic also of that city. 

ITEMS 

Dr. Herbert Berger, class of 1932, and President of the Blood Bank Association of 
New York State addressed the California Blood Bank System of the California 
Medical Association in San Francisco on February 2.^, 1957. Dr. Berger spoke on 
■'The Role of State Medical .\ssociations in Blood Banking". 

Dr. Klaus W. Berblinger of the Department of Psychiatry has announced the 
opening of his office for the practice of psychiatry at the Psychiatric Institute, Uni- 
versity Hospital, Baltimore. 



XXX BllJ.KT/X OF THE SCHOOL OF MEDICINE, U. OF MD. 

Dr. Robert C. Douglass, class of 1952, was recently awarded the degree of Master 
of Science in Internal Medicine from Wayne University College of Medicine in 
Detroit. Dr. Douglass has begun the practice of internal medicine with offices at 704 
]\Iedical Arts Bldg., LSTOO Woodward Avenue in Detroit. Dr. Douglass also serves 
as instructor in internal medicine at Wayne University College of Medicine. 

Dr. Frederick R. Simmons, class of 1950, who has recently returned from duty in 
the United Slates Air Force, has entered the practice of pediatrics at 135 Broadway, 
Daytona Beach, Florida. 

Dr. Eugene S. Bereston, class of 1937, has been named consultant for the 1957 
edition of .\cu' and y on-official Remedies published by the Council on I'harmacy and 
Chemistry of the American ]\Iedical Association. 

Dr. George H. Wall, class of 1954, is currently serving in the United States Navy 
at the United States Naval Hospital, Portsmouth, Virginia. 

Dr. Raymond H. Kaufman, class of 1948, has announced the opening of his office 
for the practice of obstetrics and gynecology at 1319 Austin Street, Houston, Texas. 

Dr. John F. Hogan, St., class of 1911, P & S and Dr. John F. Hogan, Jr., class of 
1947, have announced the removal of their offices to 2 East Read Street, Baltimore 
2, Maryland for the practice of urology. Dr. John F. Hogan, Jr. has recently been 
certified by the American Board of Urology. 

Dr. Elton Resnick, class of 1937, is currently President of the Delaware Chapter 
of the American Academy of General Practice. 

Dr. Frederic R. Simmons, class of 1950, has recently been discharged from the 
United States Air Force and has opened offices at 135 Broadway, Daytona Beach, 
Florida. Dr. Simmons is engaged in the practice of pediatrics. 

SPECIAL NOTICE 

Dear Members of the Alumni: 

Your contributions to the National Fund for Medical Education are of 
great assistance in bringing about improvement in the Medical School. 
Contributions made this year (1956) are particularly significant because: 
1. They are matched by the Ford Foundation in the amount of 70 per cent 
if the contribution is the same as last year, and 100 per cent if they exceed 
last year's gifts. 2. In the process of reorganizing the JNIedical School there 
are many urgent needs that cannot be obtained under the State appropria- 
tions allowed for the medical school. This must not be construed to mean 
we are not getting State support for our reciuests. We have received very 
reasonable consideration, but our needs are many and great and we must 
try to progress more rapidly than can be depended upon by State appro- 
priations alone. 

We urge you to support the National Fund for INIedical Education by 
gifts to them earmarked for the University of Maryland, School of Medicine. 

Gifts from Alumni to the National Fund for Medical Education are par- 
ticularly significant in that industry uses them as a criteria of the significance 
doctors attribute to the needs for increased support of medical education 
and gage their contributions to medical education accordingly. 

Sincerely, 
William S. Stone, M.D., Dean 



Dr. Edward Milton Smith, Jr. 

Dr. Edward Milton Smith, Jr., class of 1946, and a commander in the United 
States Medical Corps, was killed in an automobile accident on May 14, 1957. He w^as 
active in the lield of Preventive Medicine and Hygiene, having graduated from the 
Johns Hopkins University School of Hygiene and Public Health. During his career 
in the United States Navy he had been assigned to the Bureau of Medicine and Sur- 
gery in Washington and also had been assigned to the Portsmouth, \'irginia, Coco 
Solo, Canal Zone, and St. Albans, New York naval hospitals. Dr. Smith was the son 
of Mr. and Mrs. E. Milton Smith of lialtimore. 

Erasmus H. Kloman 

Dr. Erasmus H. Kloman, class of 1910, and long prominent in gynecologic circles 
in the city of Baltimore, died suddenly at his home on April 29, 1957, of acute coro- 
nary thrombosis. 

A man of wide interests. Dr. Kloman was active in organized medicine as well as in 
his specialty, being botli President and Secretary-Treasurer of the Medical and 
Chirurgical Faculty and for many years a member of the Maryland State Board of 
Medical Examiners. 

A native of W'arrenton, \'irginia, he was tirst graduated from the University of 
Pennsylvania as a pharmacist and practiced pharmacy in (ireenburg, Pennsylvania. 
He then began his undergraduate studies at the University of North Carolina. Fol- 
lowing his graduation from the University of Maryland School of Medicine, he in- 
terned at the University Hospital and then entered private practice. 

At the outbreak of the first World War, Dr. Kloman joined the first Maryland 
Field Hospital as a first lieutenant. He was later attached to 116th Field Hospital. 

Dr. Kloman was active in many civil and fraternal organizations. 

Dr. Richard Joseph Kemp 

Dr. Richard J. Kemp, class of 1921, died on ^lay 2, 1957 at the Hospital of the 
National Institutes of Health following a protracted illness. 

Following his graduation from medical school he served his rotating internshij) at 
the University Hospital and later entered the s])ccialty of otolaryngology. A nati\'e 
of Woodstock, Maryland and a veteran of World War 1, Dr. Kemp for many years 
was interested in the Metroi)olitan Police Boy's Club and was honored by the Wash- 
ington Mctroj)()litan Police who bestowed upon him the gold badge of Inspector in 
19.^8. 

Dr. Frank J. Schwartz 

Dr. Frank J. Schwartz, member of the class of 1907, and a prominent physician 
of Spring X'alley (near N}ack, New York) died suddenly at his home on April 22, 
1957. 



xxxii BLLLETIX OF I HE SCHOOL 01- MEDICINE, C. 01- Ml). 

Following his graduation he began praelice in Spring X'alley. During his long career 
he served actively as village trustee and acting mayor. ( )n June 18, 1956, a huge testi- 
monial dinner was gi\-en Dr. Schwartz in honor of his long and brilliant service to his 
community. 

He was past president of the Rockland County Medical Society and a member of 
many other civic organizations. 

OBITUARIES 

Allen, Wilmot B., New York City; B.M.C., class of 1898; aged 81; died, Ocloher 12, 1956. of 
ruptured abdominal aortic aneurysm. 

Becker, Leo Vitus, Patcrson, N. J.; B.M.C., class of 1906; aged 78; died, Octoljer 2i, 1956. 

Cross, Earl William, Tarentum, Pa.; P & S, class of 1908; aged 69; died, September 26, 1956. 

Disbrow, G. Ward, ()\vensl)oro, Ky.; class of 1913; aged 66; served during World War I; died, 
July 22. 1956. 

Feifer, Anthony Michael, Providence, R. I.; B.M.C., class of 1911 ; aged 70; died, October 27, 
1956, of hypertension and heart disease. 

Fisher, Charles Thompson, Salisbury, Md.; class of 1901; aged 77; died, Sei)tember 19, 1956, 
of heart disease. 

Golley, Kyle Wood, Baltimore, Md.; class of 1921; aged 59; died, September 6, 1956, of cerebral 
hemorrhage. 

Greengrass, Jacob J., Paterson, N. J.; class of 1911; aged 69; served during World War I; 
died, Octol)er 6. 1956. of coronary thrombosis. 

Haynes, James W. Dorsey, Mathews, Va.; class of 1889; aged 88; died, October 23, 1956, of 
aplastic anemia. 

Heath, J. Mott, Greenport, N. Y.; P & S, class of 1913; aged 78; died, September 20, 1956, of 
arteriosclerosis. 

Hunter, Johnson Sherman, Jackson, O.; P & S, class of 1894; aged 91; served during World 
War I; died, October 18, 1956, of arteriosclerosis. 

Jones, Edwin Murray, Fellsmere, Fla.; B.M.C., class of 1910; aged 70; died, .August 13, 1956, 
of gastrointestinal hemorrhage and arteriosclerotic cardiovascular disease. 

Katzoff, Manuel, Norfolk, Va.; B.M.C., class of 1906; aged 71; died, August 14, 1956, of cancer 
of the stomach. 

Lechner, Sidney Israel, Yonkers, N. Y.; class of 1932; aged 50; served during World War I; 
died, October 23, 1956, of acute myocardial infarction and peripheral vascular disease. 

Massenburg, George Yellott, Macon, Ga.; class of 1911; aged 68; served during World War I; 
died, September 1, 1956, of embolus to the coronary artery with heart failure and acute bacterial 
endocarditis. 

Meyers, Lloyd R., Cumberland, Md; class of 1915; aged 65, died, August 11, 1956, of coronary 
thrombosis. 

Nichols, Elijah E., Pikesville, Md.; class of 1911; aged 70; died, .April 6, 1956, of hypertensive 
arteriosclerotic heart disease. 

O'Connor, John Vincent, WOonsocket, R. 1.; P & S, class of 1911; aged 71; died, September 
14, 1956. of arteriosclerosis and myocardial infarction. 

Patterson, Frank, Tyrone, Pa.; B.M.C., class of 1902; aged 78; died, July 19. 1956. 

Smink, A. Clarence, Towson, Md.; class of 1896; aged 80; died, October 31, 1956, of cerebral 
hemorrhage. 

Steele, Guy, Cambridge, Md.; class of 1897, aged 95; died, October 12. 1956, of comi)lications 
lollowing fracture of the hip. 

Thurston, Asa, Taylorsville, N. C; class of 1909; agetl 73; died, .August 24, 1956, of arterio 
sclerosis. 

Trainor. Joseph Aloysius, Cambridge, Mass.; I' & S, class of 1905; aged (SO; died, July 13, 1956. 

Trippett, Lemuel Harrison, Jr., .\niigo, W. Va.; class of 1918; aged 60; died, September 6, 
1956, of coronary occlusion. 



MKDICAL SCHOOL SECTION 

SCHOOL